Robot-assisted transpedicular screw fixation for rheumatoid atlantoaxial dislocation with high-riding vertebral artery:a case report
Objective To explore the etiology,incidence,and selection of surgical strategy for rheumatoid atlantoaxial subluxation combined with high-riding vertebral artery(HRVA).Methods A case of robot-assisted transpedicular screw fixation for rheumatoid atlantoaxial dislocation(AAD)combined with high-riding vertebral artery was reported.Relevant literature was reviewed.Results The patient was a 56-year-old female with rheumatoid atlantoaxial dislocation,and the examination revealed high-riding left vertebral artery(V3 segment).The risk of unarmed transpedicular screw fixation was high.Guiding by robot could avoid the high-riding vertebral artery,which greatly enhanced the accuracy and stability,and reduced the risk of surgery.After the operation,symptoms were relieved and the atlantoaxial spine was repositioned.Good atlantoaxial internal fixation,clear atlantodental interval and gradually fused posterior atlantoaxial vertebrae were observed 5 months after operation.The patient returned to normal life.Conclusions Rheumatoid AAD has a higher chance of complicating with HRVA,while atlantoaxial transpedicular screw fixation assisted by robot navigation can enhance the safety and accuracy of nail placement.It significantly shortens the time of nail placement and fluoroscopy,and reduces complications of surgery such as IVAI.But the complications and long-term prognosis of robot-assisted surgery need to be reported in the literature and in more studies.In addition,problems related to the adaptation of instruments such as upper cervical hollow screws should be noted in the robot-assisted surgery.
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