Accuracy of 3D fluoroscopy-navigated anterior transpedicular screw insertion in the cervical spine: an experimental study

Robot-assisted anterior transpedicular screw fixation with 3D printed implant for multiple cervical fractures: A case report

RATIONALE

The anterior transpedicular screw (ATPS) fixation in the cervical spine provides the advantages of both anterior and posterior cervical surgery; however, it poses a high risk of screw insertion. In addition, a 3D printed implant can match ATPS fixation and reconstruction of the vertebral body. Robot-assisted surgery can make this process easier and potentially improve the safety and accuracy of the procedure.

PATIENT CONCERNS

A 64-year-old female was hit by a heavy object 4 days before presentation to our hospital. The patient exhibited a muscle strength of 0/5 in both the lower limbs and 3/5 in both the upper limbs. The visual analogue scale (VAS) for the neck was 5 points. Computed tomography (CT) of the cervical spine identified a burst fracture of the C5 vertebral body, and longitudinal splitting fracture of the C6 and C7 vertebral bodies accompanied with a split in the lamina. Magnetic resonance imaging (MRI) revealed a spinal cord edema from the C3 to the C7 level.

DIAGNOSIS

Multiple cervical fractures with spinal cord injury.

INTERVENTIONS

Anterior C4-5 and C5-6 disc resection, C5 corpectomy, robot-assisted ATPS fixation with the 3-D printed implant was performed.

OUTCOMES

The CT scans revealed a satisfactory location of the internal implantation without any signs of complications associated with implantations. Six months later, the muscle strength of both the upper limbs increased from level 3 to level 5, VAS of neck decreased from 5 to 0.

LESSONS

Robot-assisted ATPS internal fixation combined with custom implantation surgery using a 3D printed vertebral body provides an important solution to solve special cases.

Navigation for surgical treatment of disorders of the cervical spine - A systematic review

INTRODUCTION

Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery. Different techniques - each with specific advantages and disadvantages - are used in the cervical spine.

METHODS

A structured summary of different spinal navigation techniques and a review of the literature were done to discuss the advantages and disadvantages of specific navigation tools in the cervical spine.

RESULTS

In cervical spine surgery, CAN increases the accuracy of pedicle screw placement, reduces screw mispositioning and leads to fewer revision surgeries. Due to the mobility of the cervical spine, preoperative CT followed by region matching or intraoperative CT are recommended.

CONCLUSIONS

CAN increases pedicle screw placement accuracy and should be used in spinal instrumentation for the cervical spine whenever possible.

Stereotactic navigation in anterior cervical spine surgery: surgical setup and technique

Intraoperative stereotactic navigation in spine surgery is quickly becoming popularized for accurate placement of spinal instrumentation as well as assisting in the verification of anatomic landmarks. Navigation is less commonly utilized in anterior cervical spine surgery due to instrumentation being able to be placed under direct visualization. The utility of navigation in anterior cervical spine surgery is its ability to aid in the verification of anatomic location, particularly when anatomy is distorted or pathology comes close to critical neurovascular structures. We present a technique guide for anterior cervical spine navigation that we have applied at our institution and have found to be very beneficial in select patients, particularly those with complex anatomy, large body mass index, undergoing revision surgery, sustained spinal trauma and those patients with severe anterior ossification where depth or medial-lateral landmarks are difficult to visualize. We describe utilization of the technique using a case examples and specifically in a patient with significant ossification of the posterior longitudinal ligament and severe spinal cord compression that underwent multilevel cervical corpectomy. The described technique was found to be reproducible and effective, allowing cervical spine surgeons to perform more complex or minimally invasive procedures with safety and accuracy. We emphasize that navigation does not replace knowledge of anatomy or technical aspects of the procedure.

Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review

The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both anterior and posterior approaches. In recent years, with in-depth research on ATPS fixation related to anatomy, biomechanical tests, and clinical applications, its firm stability and excellent biomechanical properties have been recognized by more and more surgeons. Although ATPS fixation has been gradually applied in clinic settings under the promotion of emerging distinctive instruments, its long-term efficacy still needs to be further clarified due to the lack of large sample size studies and long-term follow-up. Nevertheless, it is believed that with the maturity of digital devices and the development of precision medicine, ATPS fixation has a promising prospect.