Robot-assisted anterior transpedicular screw fixation with 3D printed implant for multiple cervical fractures: A case report

Abstract

Rationale: The anterior transpedicular screw (ATPS) fixation in the cervical spine provides the advantages of both anterior and posterior cervical surgery; however, it poses a high risk of screw insertion. In addition, a 3D printed implant can match ATPS fixation and reconstruction of the vertebral body. Robot-assisted surgery can make this process easier and potentially improve the safety and accuracy of the procedure. Patient concerns: A 64-year-old female was hit by a heavy object 4 days before presentation to our hospital. The patient exhibited a muscle strength of 0/5 in both the lower limbs and 3/5 in both the upper limbs. The visual analogue scale (VAS) for the neck was 5 points. Computed tomography (CT) of the cervical spine identified a burst fracture of the C5 vertebral body, and longitudinal splitting fracture of the C6 and C7 vertebral bodies accompanied with a split in the lamina. Magnetic resonance imaging (MRI) revealed a spinal cord edema from the C3 to the C7 level. Diagnosis: Multiple cervical fractures with spinal cord injury. Interventions: Anterior C4-5 and C5-6 disc resection, C5 corpectomy, robot-assisted ATPS fixation with the 3-D printed implant was performed. Outcomes: The CT scans revealed a satisfactory location of the internal implantation without any signs of complications associated with implantations. Six months later, the muscle strength of both the upper limbs increased from level 3 to level 5, VAS of neck decreased from 5 to 0. Lessons: Robot-assisted ATPS internal fixation combined with custom implantation surgery using a 3D printed vertebral body provides an important solution to solve special cases.