Robot-Assisted Cervical Pedicle Screw Placement: Case Series and Technical Description

Robot-assisted (RA) techniques with pedicle implant placement have demonstrated improved accuracy and safety in thoracolumbar surgery, but their application in the cervical spine is less described. Although multiple robotic systems are currently approved for spinal fusion procedures, most studies focus on thoracolumbar instrumentation. As a result, cervical RA procedures remain underdiscussed regarding safety and efficacy.

A total of 8 patients (4 women [50%]) with a mean age of 63.1 years (range 49-75), in whom 50 cervical pedicle screws were placed, were identified. Preoperative diagnoses included degenerative (n = 2), tumor (n = 2), trauma (n = 2), and deformity (n = 2). The 50 pedicle screws were distributed at C1 (8 screws), C2 (8), C3 (6), C4 (6), C5 (6), C6 (8), and C7 (8). There was 1 inferior grade B breach on a C7 screw without clinical sequelae that was repositioned for a 98% total screw accuracy.

RA cervical pedicle screw placement appears to be a safe and effective adjunct in complex cervical spine surgery. The proposed stepwise workflow is reproducible and adaptable and includes several specific recommendations: the use of a Mayfield Halo, intraoperative computed tomography for registration, lower drill rates per minute, and additional cannulas. Further studies need to validate these findings in larger cohorts and evaluate long-term patient outcomes.