Robot-Assisted Percutaneous Lag Screw Osteosynthesis for C1 Lateral Mass Fractures: Case Series and Technical Note

C1 lateral mass fractures (LMF) cause abnormal alignment of the upper cervical joints. Conservatively treated cases can develop into late cock-robin junction, requiring a reconstructive surgical procedure of the occipitocervical junction. Partial coronal C1 LMF could be effectively fixed with lag screws. Navigation and robot-assisted techniques have made percutaneous fixation possible and are gradually being used in the upper cervical spine.

Five consecutive patients with C1 LMF who underwent percutaneous lag screw osteosynthesis under the guidance of a new robotic system were reviewed retrospectively. Preoperative and postoperative computed tomography scans were used to specify the fracture types and to assess the efficacy of fracture reduction. The medical records were reviewed.

Among the 5 patients, 4 underwent percutaneous lag screw reduction and fixation with the assistance of the robotic system through a posterior approach and 1 patient underwent a transoral approach. No intraoperative complications, such as screw malposition, neurologic deficit, and vertebral artery injury, occurred. Satisfactory fracture reduction and bone healing were achieved at postoperative follow-up.

Robot-assisted percutaneous lag screw osteosynthesis is a viable option for C1 LMF. Different approaches can be selected according to the distribution of the fracture lines. With the posterior approach, the guidewire tends to deviate from the entry point because of skiving, and the technical problems need to be further solved. Screw implant by a transoral approach is comparatively easy to achieve, but the possibly of infection exists and should be monitored.