Clinical Study of Tianji Robotic-Assisted Surgery for Upper Cervical Spine Fractures

Object: To compare the safety, clinical efficacy, and complication rate of “Tianji” robot-assisted surgery with traditional open surgery in the treatment of cervical vertebrae fracture. Methods: 60 patients with upper cervical vertebrae fracture admitted to Baise People’s Hospital between November 2018 and April 2024 were retrospectively analyzed. Among these patients, 29 underwent “Tianji” robot-assisted surgery (Robot group), and 31 underwent traditional C-arm fluoroscopy-assisted open surgery (Open group). Statistical analysis of the data was performed using SPSS 27.0 software to compare general data (gender, age, BMI), preoperative and postoperative visual analogue scale (VAS) scores, neck disability index (NDI), intraoperative blood loss, accuracy of screw placement on imaging, and the number of complications in both groups for comprehensive evaluation. A P value < 0.05 was deemed to have achieved statistical significance. Results: There was no significant difference in preoperative VAS scores between the two groups (Robot group: 8.34 ± 0.61;Open group: 8.26 ± 0.68, P = 0.317). There was also no significant difference in VAS scores at 1 week postoperatively (Robot group: 6.90 ± 0.31;Open group: 6.94 ± 0.36, P = 0.3237). Preoperative NDI scores showed no significant difference between the two groups (Robot group: 43.31 ± 2.67;Open group: 43.84 ± 2.67, P = 0.2227), and the difference in NDI scores at 1 week postoperatively was also not significant (Robot group: 35.69 ± 4.24;Open group: 37.35 ± 3.48, P = 0.0509). Intraoperative blood loss in the Robot group was significantly lower than in the Open group (246.21 ± 209 ml vs 380.65 ± 328.04 ml, P = 0.0308), with a statistically significant difference. The operation time was longer in the Robot group (3.75 ± 0.74 h) compared to the Open group (2.74 ± 0.86 h). In terms of screw placement accuracy, the Robot group had a higher accuracy rate for Class A screws compared to the Open group (102 screws vs 94 screws, P = 0.0487), and the accuracy rate for Class B screws was also higher in the Robot group (13 screws vs 29 screws, P = 0.0333), with both differences being statistically significant. There was no significant difference in the number of complications between the two groups (Robot group: 8 cases;Open group: 10 cases, P = 0.6931). Conclusion: Patients treated with “Tianji” robot-assisted surgery for upper cervical vertebrae fracture had lower intraoperative blood loss and higher screw placement accuracy compared to those undergoing traditional C-arm fluoroscopy-assisted open surgery, indicating that this robot-assisted surgery can effectively reduce intraoperative blood loss and improve screw placement accuracy.

Effects of decompression joint Governor Vessel electro-acupuncture on rats with acute upper cervical spinal cord injury

Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.

Tooth agenesis and craniofacial morphology in preorthodontic children with and without morphological deviations in the upper cervical spine

AIM: To analyze differences in prevalence and pattern of tooth agenesis and craniofacial morphology between non syndromic children with tooth agenesis with and without upper cervical spine morphological deviations and to analyze associations between craniofacial morphology and tooth agenesis in the two groups together. METHODS: One hundred and twenty-six pre-orthodontic children with tooth agenesis were divided into two groups with(19 children, mean age 11.9) and without(107 children, mean age 11.4) upper spine morphological deviations. Visual assessment of upper spine morphology and measurements of craniofacial morphology were performed on lateral cephalograms. Tooth agenesis was evaluated from orthopantomograms.RESULTS: No significant differences in tooth agenesis and craniofacial morphology were found between children with and without upper spine morphological deviations(2.2 ± 1.6 vs 1.94 ± 1.2, P > 0.05) but a tendency to a different tooth agenesis pattern were seen in children with morphological deviations in the upper spine. In the total group tooth agenesis was associated with the cranial base angle(n-s-ba, r = 0.23,P < 0.01), jaw angle(ML/RLar, r = 0.19, P < 0.05), mandibular inclination(NSL/ML, r =-0.21, P < 0.05), mandibular prognathia(s-n-pg, r = 0.25, P < 0.01), sagittal jaw relationship(ss-n-pg, r =-0.23, P < 0.5), overjet(r =-0.23, P < 0.05) and overbite(r =-0.25, P < 0.01). CONCLUSION: Etiology of tooth agenesis in children with upper spine morphological deviations was discussed. The results may be valuable for the early diagnosis and treatment planning of non syndromic children with tooth agenesis.

The surgical strategy of upper cervical dumbbell tumors

Objective To investigate the surgical strategy and prognosis of upper cervical dumbbell tumors.Methods From January 2001 to December 2009,46 consecutive cases with upper cervical dumbbell tumor were retrospec-tively studied on

Microsurgical treatment of neurilemmoma in upper cervical spinal canal:59 cases report

Objective To explore surgical techniques and curative effects of microsurgical treatment for neuriemmoma in upper cervical spinal canal. Methods Form Jan. 2004 to Nov. 2007. 59 cases of schwannoma was resected through microoperation, the operation was conducted through a posteromedial approach,using German Laika microscope resection

Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients

The application of C1-C2 pedicle screw internal fixation on the upper cervical diseases of children

Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point

Schwannoma of the upper cervical spine-a case report

Upper cervical schwannoma is rare,and belongs to benign tumors that is usually asymptomatic.It accounted for only ten percent of schwannomas cases and mostly occurs in 40-50 years old patients.Aggressive and total resection is the treatment of choice for this tumor.Preoperative diagnosis is difficult,relying on clinical suspicion,and confirmed by surgical pathology.We report a 54-year-old male patient with chief complain of progressive weakness and numbness of his right arm for four months.He had a history of lymph node tumor in 2007 and excised in 2011.Neurological decrease was found on the right arm.The radiographic examination showed lytic lesion on the second,third,and fourth cervical spine.Computed tomography scan showed destruction extending to the first cervical vertebra.Capsulated extradural and extramedullary mass and compression to the spinal cord was found from the magnetic resonance imaging.Two-stage operation was performed.The first stage was posterior decompression with occipitocervical fusion and instrumentation,while the second was anterior decompression and iliac strut graft.Both operations performed using the surgical ultrasonic dissector.During three months'follow-up,it showed neurological improving.Neurological deficit appears when there is compression on the spinal cord.Total resection is the treatment of choice for these tumors.Preoperative imaging should be performed to exclude malignant tumor and found tumor extension.

Intraosseous lipoma of adjacent upper cervical vertebral bodies with significant paravertebral expansion

Intraosseous lipomas are rare, benign bone tumors,comprising less than 0. 1% of all primary bone tumors.Common sites of intraosseous lipomas include the os calcis and the metaphyses of the long bones of the lower limbs.2 Cases involving the spine are extremely rare; a meta-analysis of 206 cases reported that intraosseous lipomas involving the spine （including the sacrum）accounted for 6% of all cases.2 A review of the English literature reveals only 14 reported cases involving the spine （Table）.

多层螺旋CT在上颈椎损伤中的诊断价值

目的探讨多层螺旋CT（MSCT）三维及多平面重建在上颈椎损伤中的临床应用价值。方法25例上颈椎损伤患者，采用MSCT3～5mm扫描、1．0mm重建后作三维及多平面重建。结果上颈椎椎体骨折18例，其中齿状突骨折6例，环枢关节脱位7例，其中环齿关节脱位6例，单纯枢椎旋转脱位1例。结论螺旋CT三维及多平面重建能明确显示上颈椎骨折、脱位情况，有助于临床及时准确地制订治疗方案。

A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2 intralaminar screw fixation

Background The objective of this study was to use three-dimensional finite element （FE） models to analyze the stability and the biomechanics of two upper cervical fixation methods：the C2 intralaminar screw method and the C2 pedicle screw method.Methods From computed tomography images,a nonlinear three-dimensional FE model from C0 （occiput） to C3 was developed with anatomic detail.The C2 intralaminar screw and the C2 pedicle screw systems were added to the model,in parallel to establish the interlaminar model and the pedicle model.The two models were operated with all possible states of motion and physiological loads to simulate normal movement.Results Both the C2 intralaminar screw method and the C2 pedicle screw method significantly reduced motion compared with the intact model.There were no statistically significant differences between the two methods.The Von Mises stresses of the internal and external laminar walls were similar between the two methods.Stability was also similar.Conclusions The C2 intralaminar screw method can complement but cannot completely replace the C2 pedicle screw method.Clinicians would need to assess and decide which approach to adopt for the best therapeutic effect.