Robot-Assisted Percutaneous Transpedicular Lag-Screw Fixation for Hangman's Fracture: A Retrospective Case Series

This study aimed to evaluate the short-term feasibility, safety, and clinical outcomes of robot-assisted percutaneous transpedicular lag-screw fixation for Hangman's Fracture.

Twelve patients with acute Hangman's fractures were treated using robot-assisted percutaneous transpedicular lag-screw fixation. Neurological function was assessed using the American Spinal Injury Association (ASIA) Impairment Scale. Operative parameters and Visual Analog Scale (VAS) scores for neck pain were recorded. Screw placement accuracy was graded according to the Gertzbein and Robbins classification. Preoperative and postoperative displacement and angulation at C2-C3 segment were measured.

All 12 procedures were successfully completed without neurovascular complications. The mean operative time was 55 ± 6.3 minutes, with mean estimated blood loss of 12 ± 5.8 mL (mL). A total of 23 screws were implanted, with 22 graded A and 1 graded B according to the Gertzbein and Robbins scale. Significant improvements were observed in VAS scores, compared to preoperative values (P < 0.001). The mean displacement distance decreased from 4 ± 0.9 mm preoperatively to 1 ± 0.5 mm postoperatively. The mean angulation decreased from 8° ± 2.3° preoperatively to 2° ± 0.9°. Bony union was achieved in all patients, with a mean time to union of 3.3 ± 0.9 months.

Robot-assisted percutaneous transpedicular lag-screw fixation appears to be a feasible, precise, and minimally invasive technique for Hangman's fracture.