Case Reports
doi: 10.21037/jss-20-676.
Affiliations
Affiliations
- 1 Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
- 2 Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Case Reports
David T Asuzu et al.
J Spine Surg.
2021 Sep.
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doi: 10.21037/jss-20-676.
Affiliations
- 1 Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
- 2 Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Abstract
Robotic-navigated screw placement has potential for higher precision and accuracy. Robotic assistance is well-described in the lumbar spine, however only few studies have evaluated its use in the cervical spine. Surgical treatment for hangman’s fractures after nonunion typically involves C2-3 anterior fusion or posterior occipito-cervical fusion. However, occipito-cervical fusion involves loss of mobility in the cervical spine with associated morbidity. We have previously described a minimally invasive approach using percutaneous screw fixation with X-ray navigation. Robotic assistance is ideally suited for cervical fusion given smaller bony anatomy and adjacent critical structures. We describe a young healthy patient who presented with a hangman’s fracture initially managed conservatively with immobilization. She presented with nonunion and persistent symptoms. Surgical options considered included anterior cervical discectomy and fusion, or posterior cervical fusion with or without extension to the occiput. These options would have involved some loss of flexion/extension and rotational motion with associated morbidity. We performed percutaneous screw fixation of the hangman’s fracture using MAZOR-X robotic navigation and achieved good radiographic fracture reduction with accurate screw placement. To our knowledge this is the first case of a robotic-assisted percutaneous screw fixation for a hangman’s fracture. Robotic-navigated screw placement can be used safely and accurately for cervical spine fractures.
Keywords:
Hangman’s fracture; case report; percutaneous screws; robotic assistance.
2021 Journal of Spine Surgery. All rights reserved.
Conflict of interest statement
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jss-20-676). The authors have no conflicts of interest to declare.
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