Preserving Cervical Mobility: A Novel Robot-Assisted Approach for Atlas Fracture Fixation

BACKGROUND The management of unstable atlas fractures remains a subject of ongoing debate and controversy. The conservative surgical treatment commonly involves fusion, resulting in severe loss of cervical spine mobility, and a large incisions and extensive tissue dissection are required. We aim to introduce a novel concept and surgical approach for treating atlas fracture, one that involves minimizing trauma while maintaining mobility of the upper cervical spine without resorting to fusion. CASE REPORT We present the case of a 48-year-old woman with an atlas fracture who underwent robot-assisted pedicle screw placement via biportal endoscopy technique. We seek to introduce a novel concept and surgical approach for treating atlas fracture, one that involves minimizing trauma while maintaining mobility of the upper cervical spine without resorting to fusion. The patient's preoperative VAS score for neck pain was 7, which improved to 3 postoperatively. The right and left cervical rotation improved from 15° preoperatively to 50° postoperatively. Preoperative CT and MRI scans demonstrated satisfactory reduction of the anterior and posterior arch fractures and satisfactory fixation position of the pedicle screws. She was discharged 4 days later, and she had good range of flexion, extension, and rotation of the cervical spine 2 months after surgery. CONCLUSIONS Robot-assisted percutaneous atlas pedicle screw placement via biportal endoscopy is a beneficial surgical treatment for atlas fractures. This technique offers satisfactory alignment and union of the fractures and preservation of atlanto-axial joint motion while having the advantages of minimal invasiveness, rapid postoperative recovery, and fewer complications.