Evaluating the feasibility of pinless robot-assisted spine surgery: a prospective study of 750 cases and 3,924 screws in the thoracolumbar spine in India.

Study design: This single-center prospective study compared pin-mounted and pinless robot-assisted techniques for thoracolumbar pedicle screw placement.

Purpose: To evaluate the feasibility, accuracy, and safety of a novel pinless technique in comparison to the traditional pin-mounted method in thoracolumbar fusion surgery.

Overview of literature: Robot-assisted spine surgery has enhanced the precision of pedicle screw placement and reduced radiation exposure. While conventional pin-mounted techniques are effective, they can lead to hardware-related complications. Emerging evidence indicates that eliminating bone-mounted fixation could streamline the surgical workflow without compromising accuracy or safety.

Methods: A total of 750 consecutive patients who underwent robot-assisted thoracolumbar fusion were enrolled. Two groups were defined: 200 cases (890 screws) using the pin-mounted approach and 550 cases (3,034 screws) utilizing the pinless method. All procedures employed intraoperative computed tomography imaging and a standardized protocol with a table-mounted robotic system. Screw accuracy was assessed using the Gertzbein-Robbins grading system, with grades A and B classified as acceptable. Secondary parameters, including operative time, blood loss, and radiation exposure, were also recorded.

Results: The pin-mounted group achieved an overall pedicle screw accuracy of 99.55% compared to 99.40% in the pinless group (p >0.05). There were four breaches in the pin-mounted group and 18 breaches in the pinless group, all of which were revised intraoperatively, with no permanent neurovascular injuries or major complications reported. Blood loss and radiation exposure were similar between the groups.

Conclusions: The pinless robot-assisted pedicle screw placement technique demonstrates accuracy and safety comparable to the traditional pin-mounted method. By eliminating bone-mounted fixation, this approach simplifies the surgical workflow and reduces hardwarerelated complications, making it an effective alternative for thoracolumbar fusion surgery.