Robot-assisted screw fixation in upper cervical spine using TiRobot system: an accurate and reliable procedure

INTRODUCTION Screw fixation in upper cervical spine surgery is one of the most challenging spinal procedures. Vital anatomical structures, including vertebral arteries, spinal cord and upper cervical nerve roots, are adjacent to the screw trajectories. For that reason, the free-hand techniques are not a reliable procedure in upper cervical spine1. As a result, navigation-assisted screw fixation is becoming widely used. Bredow et al2 reported on their use of navigation with good results. However, the limitation of surgeons, such as insufficient steadiness and force control and a steep learning curve, may cause severe problems during procedures. For severe deformity, even when surgeons use navigation to identify the perfect trajectory, screw insertion may still be difficult. Wei Tian3 Health