Robotisch assistierte und navigierte Pedikelschraubenplatzierung an der subaxialen Halswirbelsäule
摘要
The aim of this surgery is to stabilize an unstable cervical spine injury.
IndicationsType 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.
ContraindicationsRobotically assisted and navigated techniques have no special contraindications.
Surgical techniquePerformed 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 stepsPreoperative: planning CT and screw planning.
IntraoperativeCarbon 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-upNo 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.
EvidenceThe 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.