Robotic assistance for upper cervical instrumentation: report on accuracy and safety.

Purpose: This study aims to evaluate the accuracy and safety of C1 lateral mass and upper cervical pedicle screw placement assisted by the TiRobot II system.
Methods: Ten patients who underwent cervical spine surgery assisted by the TiRobot II system were included. Screw accuracy was assessed using the Gertzbein-Robbins scale and by comparing the final screw positions with pre-planned trajectories. Deviations in screw tip, tail, and angle were recorded. Clinical data, including symptoms, surgical outcomes, and postoperative follow-up, were collected. Neurological improvement was evaluated using pre- and post-operative mJOA scores, with recovery rates calculated by Hirabayashi's method to assess outcomes 3 months after surgery.
Results: A total of 30 screws were placed in 10 patients. All screws (30/30) were within the clinically acceptable range, with 93.33% (28 screws) classified as Grade A and 6.67% (2 screws) as Grade B. In the sagittal plane, the average tip deviation was 1.82 ± 0.79 mm, tail deviation 1.64 ± 0.60 mm, and angular deviation 1.92 ± 1.39°. In the axial plane, tip deviation was 1.96 ± 0.87 mm, tail deviation 1.92 ± 0.65 mm, and angular deviation 2.01 ± 1.07°. The average surgery time was 318.80 ± 66.07 min, with a mean EBL of 205.00 ± 55.03 mL. Postoperative mJOA scores significantly improved from 8.10 ± 1.97 to 12.60 ± 1.78 (p < 0.05), with a 52 ± 14% recovery rate. All patients showed significant symptom improvement.
Conclusion: The TiRobot II system demonstrates the capability to precisely execute pre-planned trajectories and improves the accuracy and safety of C1 lateral mass and upper cervical screw placement.
Competing Interests: Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethical approval: This study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University. This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the hospital institutional review board (Ethics Approval Number 2020SYSUSH-001).
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)