Robotisch assistierte und navigierte Pedikelschraubenplatzierung an der subaxialen Halswirbelsäule

Abstract

OBJECTIVE OF SURGERY: The aim of this surgery is to stabilize an unstable cervical spine injury. INDICATIONS: Type B2 injury according to the AOSpine classification for injuries of the subaxial cervical spine and the associated instability. Guidelines and treatment recommendations for this injury. CONTRAINDICATIONS: Robotically assisted and navigated techniques have no special contraindications. SURGICAL TECHNIQUE: Performed in the 3D navigation hybrid operating theatre "Robotic Suite" consisting of navigation unit "Curve Navigation System", robotic 3D cone beam computed tomography (CBCT) "Loop-X", robotic arm "Cirq Arm System" and wall monitor "BUZZ" (Brainlab, Munich, Germany). The individual surgical steps are explained in the video (English), available on the website under "Supplementary Information" or via the QR code. SURGICAL STEPS: Preoperative: planning CT and screw planning. INTRAOPERATIVE: Carbon table, prone position and Mayfield clamp. Dorsal approach. Attachment of the reference array. 1) CBCT scan. Image fusion. Control of fusion result. Robot arm approach to the drilling trajectory, robotically assisted drilling. Insertion of the K‑wire. Navigated threading and navigated screw placement. 2) CBCT scan, control of the screw positions. Satisfactory screw position, insertion of connecting rods and bone substitute material, sterile wound closure. FOLLOW-UP: No cervical orthosis necessary. Isometric physiotherapy. Adapted pain therapy as needed and according to WHO scheme. X‑ray control after 6 and 12 weeks. No metal removal. EVIDENCE: The video material shown is from a routine clinical operation. Robotically assisted and navigated operations at the subaxial cervical spine are performed with good surgical results and a high accuracy.