Enhanced accuracy and safety of TiRobot-assisted pedicle screw placement in spinal deformity: an age-stratified meta-analysis.

To compare the efficacy and safety of TiRobot-assisted versus conventional surgery for spinal deformity through meta-analysis, with age-stratified subgroup analyses in pediatric and adult patients. Comparative studies assessing TiRobot-assisted and conventional surgery for spinal deformity were systematically retrieved. Pooled analyses were conducted for operative outcomes, perioperative parameters, radiographic correction, pedicle screw accuracy, complications, and postoperative functional outcomes. Pediatric and adult subgroup analyses were subsequently performed. TiRobot-assisted surgery was associated with longer operative time overall, with statistical significance observed in pediatric patients. Screw insertion time was significantly shorter only in the pediatric subgroup. Intraoperative blood loss was significantly reduced in both pediatric and adult patients receiving TiRobot assistance. Adult patients in the TiRobot-assisted group had shorter hospital stays, whereas pediatric patients underwent fewer fluoroscopic exposures. Although overall radiographic correction was largely comparable between groups, TiRobot assistance significantly improved pedicle screw accuracy. The proportion of Gertzbein-Robbins grade A + B screws was higher, particularly in pediatric patients, while the proportion of grade 0 + 1 screws was higher in adults. In addition, TiRobot-assisted surgery significantly reduced overall and neurologic complication rates, with the reduction in neurologic complications being particularly evident in adult patients. TiRobot-assisted surgery for spinal deformity improves pedicle screw placement accuracy and perioperative safety while providing selective advantages in perioperative recovery. The pattern of benefit differs between pediatric and adult populations, but the overall balance of evidence favors TiRobot assistance over conventional techniques.