Robot-Assisted Posterior C1–2 Transarticular Screw Fixation for Atlantoaxial Instability

STUDY DESIGN: Case report. OBJECTIVES: The aim of this study was to assess the feasibility, safety, and accuracy of a new robotic system for performing posterior C1-2 transarticular screw fixation for atlantoaxial instability. SUMMARY OF BACKGROUND DATA: C1-2 transarticular fixation is a reliable procedure. However, the procedure is high-risk because of the important structures and frequent anatomical variation around the atlantoaxial region. Navigation improves the accuracy, but it might require repeated adjustments of the trajectories, which is inconvenient. Robot-assisted surgery can make this process easier and has the potential to improve the safety and accuracy. METHODS: A 43-year-old man with atlantoaxial deformity and instability underwent posterior C1-2 transarticular screw fixation under the guidance of the new robotic system (TiRobot, co-designed by Beijing Jishuitan hospital and TINAVI Medical Technologies Co., Ltd.). We performed a surgery of posterior decompression and C0-2 fusion. Based on the intraoperative 3D images, we planned the trajectory on the robot system. Then, the robotic arm spontaneously moved to guide the screw insertion. RESULTS: A unilateral C1-2 transarticular screw was safely placed with good accuracy. The calculated deviation of the planned position and actual position was 0.8798 mm. There were no intraoperative complications. Postoperative computed tomography showed there were no perforations and loosening of the screw. CONCLUSION: We report the first case of atlantoaxial transarticular screw fixation using the TiRobot system. Robotic guidance for complex upper cervical deformity based on intraoperative 3D images could be feasible, safe, and accurate, and has a significant clinical potential in spine surgery. LEVEL OF EVIDENCE: 4.