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Best of Both Worlds: Use of Robotic Principles for Placing Navigated Cervical and Difficult Upper Thoracic Pedicle Screws, a Technical Nuance.

Diogo Moniz GarciaAlaa MontaserSelby ChenEric NottmeierStephen Pirris
Published in: World neurosurgery (2024)
Navigated pedicle screw placement can be particularly challenging for cervical and upper thoracic levels in obese patients. This technical challenge can be compounded by smaller-diameter tools, which can be flexible and therefore confound navigation. It is imperative to avoid excessive manipulation of surrounding tissues to maintain navigation accuracy in the mobile cervical spine. 1 Robotic-assisted spinal approaches use firm guides to aid drilling and screw placement but are hindered by high costs with equipment acquisition. 2 , 3 Here, we propose a technical nuance that combines robotic surgical principles with tools that are more readily available in many surgical departments (Video 1). We present the case of a 64-year-old woman with a chief complaint of neck pain, irradiating to the left worse than right arm and prior history of C5-7 anterior cervical diskectomy and fusion. Imaging showed multilevel degenerative disease and a solid prior C5-7 anterior cervical diskectomy and fusion with grade I anterolisthesis at C7-T1 due to severe facet degeneration with severe left-sided foraminal stenosis. Given failure of conservative management, the patient was brought to the operating room for left C7-T1 foraminotomy and C7-T1 posterior instrumented fusion. Here, we show the use of a tubular retractor fixed to the surgical bed for solid and reproducible trajectory for all tools to minimize the risk of surrounding tissue manipulation and its effect on navigation accuracy.
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