Minimally invasive instrumented fixation for Hangman's fracture assisted by the TiRobot system: A case report

Freehand screw placement in upper cervical surgery can be technically challenging. Therefore, navigation techniques are increasingly being used to improve safety and accuracy. However, the use of robots in cervical screw insertion is often limited due to issues with skiving and poor accuracy.

A 51-year-old male who presented with neck pain following a car accident was diagnosed with type I hangman's fracture without neurological deficiency. To avoid traction and external immobilization, we safely and accurately placed two cannulated screws into the lamina and pedicle of C2 using the TiRobot system. The procedure involved minimal soft tissue dissection, and the patient was discharged on day 3 without a cervical collar. At the six-week and 1-year follow-up, the patient had no neck pain and showed good range of motion in the cervical spine.

During the procedure, certain techniques can help improve the safety and accuracy of screw insertion.

Our experience suggests that the intraoperative 3-dimensional image-based robotic guidance for upper cervical surgery is feasible, safe, and accurate.