Comparative clinical performance of robotic-assisted systems in spinal deformity surgery: focus on perioperative outcomes and pedicle screw accuracy.

To compare the clinical effectiveness and safety of the TiRobot and Mazor robotic systems in spinal deformity surgery, with additional stratified analyses based on deformity type, including adolescent idiopathic scoliosis (AIS) and adult degenerative scoliosis (ADS). PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for comparative studies published up to February 1, 2026. Subgroup analyses were prespecified according to robotic platform (TiRobot vs. Mazor) and deformity type (AIS vs. ADS). Perioperative outcomes, radiographic parameters, pedicle screw accuracy, and safety endpoints were quantitatively synthesized. Compared with conventional techniques, robotic-assisted surgery was associated with prolonged operative time (MD = 29.64 min, P < 0.01), significantly improved pedicle screw accuracy (OR = 6.51, P < 0.01), and reduced radiation exposure (MD = − 5.27, P < 0.01), while no significant differences were observed in blood loss, hospital stay, or Cobb angle correction. Platform-based subgroup analyses indicated that TiRobot was associated with reduced intraoperative blood loss and shorter hospitalization, whereas Mazor demonstrated greater improvements in thoracic kyphosis and MT values. Disease-based subgroup analyses showed that operative time remained significantly longer in the AIS subgroup, whereas a shorter length of hospital stay was observed in ADS patients. No significant differences were detected in other outcomes across disease subtypes. Robotic assistance enhances pedicle screw accuracy and reduces radiation exposure. Both platform-specific and disease-specific differences exist in perioperative and radiographic outcomes, highlighting the importance of individualized surgical strategy based on both robotic system and deformity type.