Cirq® Robotic Assistance for Minimally Invasive C1-C2 Posterior Instrumentation: Report on Feasibility and Safety

BACKGROUND: Accurate screw placement remains very challenging especially in the upper cervical spine. OBJECTIVE: To present our first experience of a percutaneous posterior C1-C2 fixation for a traumatic fracture. METHODS: This is a case report of a non-neurological patient, harboring a type II odontoid fracture. She underwent a posterior percutaneous fixation using Cirq (R) Robotic Assistance coupled to the AIRO (R) intraoperative computed tomography (iCT)-scan and BrainLab (R) navigation system (all by BrainLab AG). Routine CT was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated. RESULTS: The C1-C2 posterior percutaneous fixation was performed with cannulated VERTEX (R) Reconstruction System (Medtronic). Overall, 4 screws were placed. All of them were rated as acceptable (100%). Radiation dose received by the patient was 4.13 mSv. Radiation dose received by the surgical staff was 0 mSv. Postoperative course was excellent. CONCLUSION: Posterior percutaneous fixation using Cirq (R) Robotic Assistance coupled with iCT navigation system is a major innovation that can improve pedicle screw positioning's accuracy with acceptable patient radiation and reduced surgical team exposure.