Operative Neurosurgery. 2026;31(2):202–222
Objective
To assess the accuracy and safety of robotic pedicle-screw placement in pediatric spinal surgery.
Methods
The study combined a seven-patient institutional series with a systematic review and meta-analysis including approximately 900 pediatric patients. Most patients had adolescent idiopathic scoliosis.
Main results
Across 11,434 screws, mean placement accuracy was 97.2%, the malposition rate was 2.67% and the reported revision rate was 0.79%. In the institutional cohort, accuracy was 91.7%, with one intraoperative screw revision. Meta-regression suggested improving accuracy and decreasing durotomy rates over time.
Interpretation
Robotic guidance can provide high pedicle-screw accuracy in pediatric deformity surgery. The evidence supports feasibility and safety but does not establish superiority over modern navigation or carefully performed freehand techniques.
Limitations
The institutional cohort was very small. Included studies were predominantly observational and heterogeneous in robotic platforms, deformity complexity and accuracy definitions.
Clinical takeaway
Robotics is a useful adjunct for complex pediatric instrumentation, but its benefit depends on planning, registration quality, surgeon oversight and the ability to recognize navigation error.
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