Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis

Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis Songchuan Zhao, Yang Bo, Jinpeng Du, Liang Yan, Dingjun Hao, Haosheng Wang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-885390/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Anterior odontoid screw fixation is considered to be preferred surgical treatment for the type Ⅱ odontoid fractures. However, due to the high difficulty to insert odontoid screw with barehand, the high risk of screw misalignment and damage to surrounding important tissue structures, we urgently need robot-assisted screw insert navigation technology to improve the safety and accuracy of inserting odontoid screws. Methods: We retrospectively analyzed 7 patients with type II odontoid fractures who underwent Tinavi robot-assisted screw insert technology from May 2018 to May 2019 at our hospital. All patients had received 64-row CT scans and 3D reconstructions completed preoperatively, and magnetic resonance (MRI) were performed to verify the severity of odontoid fractures, soft tissue injuries and vertebral artery height. Postoperative CT was repeated in 6 months after surgery to evaluate cervical stability and confirm whether the screw had breached the bone cortex, the accuracy of screw placement based on Rampersaud A-D grade. Functional recovery was assessed using the post-traumatic Mayor scoring system for the cervical spine. Results: All 7 patients successfully completed the robot-assisted operation without nerve and blood vessel damage. What is the operation time 103.3 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative CT of these 7 patients showed that the cervical spine was stable, the accuracy of “perfect” and “clinically acceptable” odontoid screw implantation was 100% (7/7), none of the seven odontoid screws breached the bone cortex. Reexamination of X-rays showed that the fractures were all healed, and the average fracture healing time was average 13.7weeks (12-15weeks). During the follow-up period, 7 patients had no surgical complications, postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case. Conclusion: Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures. Orthopedics Tinavi Robot Type Ⅱ odontoid fractures Screw fixation Figures Figure 1 Figure 2 Background Anterior odontoid screw fixation is the preferred surgical method for the type II odontoid fractures as for as it can preserve the range of motion of the atlantoaxial joint( 1 ). More and more scholars advocate the treatment of type II odontoid fractures with fixed surgery within first stage( 2 ). However, due to the high difficulty of the operation and the complex anatomical structure of the upper cervical spine, the clinical application of anterior odontoid screw fixation is limited. Even though surgeons who under high doses of radiation may still be impossible to safely and accurately complete the anterior screw insertion( 3 ). The surgical robot system has many characteristics such as high operation accuracy, good operation repeatability, excellent surgical stability, less traumatic surgery, in addition, it’s worth noting that surgeons are exposed to less radiation, meanwhile, its application in upper cervical spine surgery has get more and more attention and research from clinicians( 4 , 5 ). Tinavi orthopedic robot system is the world's first surgical robot that combines computer-aided navigation, real-time optical tracking and robotic arm technology( 6 ), which is based on intraoperative three-dimensional (3-D) images (Figure 1 ). Tinavi orthopedic robot system has three components: navigation design system, optical tracking system and robotic arm system( 7 ). The actual workflow is as follows: first, clinicians apply the 3-D C-arm (Siemens Medical Solutions, Erlangen, Germany) to acquire a set of intraoperative images. Due to the need for high-precision calculations on the computer, the 5 positioning points on the positioning ruler must be included in the 3-D C-arm scan range. Then the clinician upload the image to the robot workstation,and design the screw entry point, screw insertion trajectory and screw specifications in the workstation according to the intraoperative 3-D images. The optical tracking system consists of an infrared stereo camera and two tracers. One tracer is fixed on the patient’s spinous process or skin, and the other is fixed on the end of the robotic arm. This enables the optical tracking system to locate the robotic arm and the patient, it also could guide the robotic arm to the planned surgical location. The robotic arm can cover all spine parts. Under the guidance of navigation design and optical tracking system, the robotic arm automatically moves to the desired position accurately( 8 , 9 ). The author has treated 7 cases of type Ⅱ odontoid fractures with anterior odontoid screw internal fixation under the navigation of Tinavi orthopedic robot from May 2018 to May 2019 (Demographic data and general clinical information of seven patients, Table 1 ). Table 1 Demographic data and general clinical information of seven patients. Demographic data and general clinical information of seven patients M male,F female Patients 1 2 3 4 5 6 7 P Sex M M M F M F M - Age 43 63 29 42 36 53 33 42.7 Cause of injury traffic accident traffic accident falling injury traffic accident traffic accident falling injury traffic accident - Operation time(min) 90 75 85 110 100 85 75 103.3 Intraoperative blood loss(ml) 5 10 8 20 12 8 15 11.1 Rampersaud score(A-D grade) A A A A A A A - Pain VAS score 0 1 0 2 1 1 0 0.7 Fracture healing time(week) 15 12 15 12 15 12 15 13.7 Materials And Methods General information Inclusion criteria: ( 1 ) Type II odontoid fracture, mild to moderate displacement ; (2) Without nerve or vertebral artery injury; (3) 18-70 years old. Exclusion criteria: (1) Combined with severe medical disease or multiple injuries and unable to tolerate surgery; (2) Combined with nerve/vascular injury requiring open surgical exploration and decompression; (3) Lost to follow-up within three months after surgery. Include 7 cases, 5 males and 2 females, aged 29-63 years old, average 42.7 years old. Causes of injury: 5 cases were injured by car accidents, 2 cases were injured by falling from height; 3 cases had limb fractures, 2 cases had closed chest injuries, and 2 cases had only neck pain and limited mobility. Before surgery, all patients had completed 64-slice CT scans and 3-D reconstructions, and performed MRI examinations to understand type Ⅱ odontoid fractures, soft tissue injuries and vertebral artery heights. Operation method: General anesthesia, take the supine position, fix the patient's head on the Mayfeild head frame, confirm the fracture reduction under the C-arm X-ray machine, and connect the robot parts and accessories, including the mechanical arm, surgical planning and navigation system, and optical positioning Tracking system and 3-D C-arm. Intraoperative CT scan to obtain 3D images: send the images to the dimensity Robot Surgery Planning and Navigation System. The assistant calls up the reconstructed image on the planning workbench, and plans the needle insertion point and needle direction in the odontoid axis, sagittal, and coronal positions, so that the guide needle passes through the main fracture line, confirm it not breached the bone cortex, and the mechanical arm is moved to simulate the running track. Measure the diameter and length of the required dentate screw. The guide needle is inserted under the guidance of the robot arm and verified. The robot arm is operated according to the predetermined trajectory, so that the tip of the guide needle sleeve on the robot arm slightly touches the bone at the needle insertion point, and the power drill is inserted under the guide of the sleeve Guide needle, confirm the position and insertion depth of the guide needle under fluoroscopy; Measure the diameter and length of the required dentate screw. The guide needle is inserted under the guidance of the robot arm and verified. The robot arm is operated according to the predetermined trajectory, so that the tip of the guide needle sleeve on the robot arm slightly touches the bone at the needle insertion point, and the power drill is inserted under the guide of the sleeve Guide needle, confirm the position and insertion depth of the guide needle under fluoroscopy. Postoperative treatment and follow-up: Antibacterial drugs were routinely used within 24 hours after surgery. Patients were encouraged to wear a cervical collar to protect them from getting out of bed on the first day after surgery. Cervical X-rays and CT scans were reviewed 3 days after surgery. The neck brace was removed after 4 weeks, and active neck exercises were started. Regular follow-ups were performed after the operation, and the cervical spine was taken in front and side view and dynamic position, and CT thin-layer scanning was performed to evaluate the stability of the cervical spine and fracture healing. Six months after surgery, the Mayor scoring system after cervical spine trauma was used to evaluate the patient's functional recovery. Results All 7 patients in this group successfully completed the operation without nerve and blood vessel damage. What is the operation time 110 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative re-examination of the cervical spine in positive and lateral and dynamic position X-rays showed that the cervical spine was stable, and there was no failure of internal fixation or fracture displacement during the follow-up. All 7 cases were followed up satisfactorily, average follow-up time 12.4 Month (6-24 month), during the follow-up period, 7 patients had no surgical related complications. Postoperative CT showed that the fractures were all healed, and the average fracture healing time was average 13.7 weeks (12-15weeks) (Table 1 ). Pain VAS score 0-2 points, average 0.7 points. The cervical spine range of motion is scored 2-5 points before surgery, with an average of 3.43 points, 3 days after surgery, cervical motion score was 1-2 points, with an average of 1.43 points(Figure 2 ). 6 months postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case. Discussion Odontoid fractures account for 15%-20% of all cervical spine fractures, and type II fractures account for 65%-74% of all odontoid fractures. Type II odontoid fractures are unstable fractures, and the rate of nonunion in conservative treatment is relatively high( 10 ). Anterior odontoid screw internal fixation can achieve immediate fracture fixation and it can preserve the range of motion of the atlantoaxial joint. The advantage is that it retains the rotation of the C1-C2 vertebral body, has a higher fusion rate and better clinical effects than external fixation( 11 ). Due to the special anatomical structure of the odontoid process and the distribution of important nerves and blood vessels around it, coupled with unstable fractures and displacement after fractures, it increased the difficulty of inserting screw under the guidance of traditional freehand fluoroscopy for surgeons( 12 ). Orthopedic robots can assist clinicians in intelligent surgical planning and precise intraoperative operations, effectively reduce clinicians’ human errors during the operation, realize intelligent human-computer interaction, and perfectly control surgical accuracy through digital navigation throughout the process( 13 ). Robot-assisted screw insert technology has achieved higher accuracy than traditional barehand fluoroscopy in other positions of the spine, and can provide real-time dynamic adjustment during the operation( 7 ). If the pedicle screw implantation deviation occurs during the operation, the orthopedic robot can also be timely. The feedback on the screen is convenient for the doctor to adjust to the preoperative setting position( 14 ). The results of meta-analysis by Fan et al. showed that compared with hand nail placement, the proportion of robot-assisted nail placement reaching A (Gertzbein-Robbins’s classification) was higher ((odds ratio 95%, "perfect accuracy" confidence interval: 1.38-2.07, P < .01; odds ratio 95% "clinically acceptable" Confidence Interval: 1.17-2.08, P < .01).) ( 14 , 15 ). Molliqaj et al. reported that in the placement of pedicle screws, the clinical acceptance rate of robot-assisted screws was 93.4%, which was higher than 88.9% of traditional fluoroscopy( 16 ). Intelligent surgical planning technology is based on CT for 3D intelligent modeling, providing patients with personalized surgical plans( 17 ). According to the patient's personal situation, select the appropriate pedicle screw size, set the implant position and angle, and simulate soft tissue. The balance of the situation. The robot performs intelligent operation, the operation process is stable, and the operation time is shortened to 103.3 minutes, effectively reducing the amount of bleeding during the operation(11.1ml). The actual size, screw position and angle of the pedicle screw used are consistent with the preoperative plan height, reducing the possibility of surgical complications. As far as post-operative rehabilitation is concerned, it is also conducive to shorten the length of hospitalization, speed up post-operative rehabilitation, and reduce hospitalization costs( 18 ). Especially for patients with atlantoaxial fractures, the biggest advantage of the robotic surgery system is that the pedicle screw placement is safer and more precise, the incision is smaller, the injury is less, the bleeding is less, and the patient recovers more quickly( 19 ). Compared with traditional treatment methods, the robot-assisted nail placement has no X-ray exposure during the entire operation. However, this study also has limitations. First of all, it is difficult to draw more reliable conclusions due to fewer cases( 20 ). However, the purpose of this study is to illustrate the feasibility of a new treatment method for odontoid fractures, so a small sample size can basically be Meet the needs of research. Secondly, this study did not conduct a prospective randomized controlled study of robot-assisted nail placement and other treatment methods. Therefore, it is necessary to further carry out multi-center and large-sample randomized controlled trials to further verify the results of this study. Conclusion Robotic assisted laparoscopic nephropexy can be safely and effectively performed in a spinal surgery. Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures. Abbreviations MRI: magnetic resonance; CT: computed tomography Declarations Ethics approval and consent to participate This study is based on the SEER database and does not require ethical approval. Consent for publication Not applicable. Availability of data and materials The data set supporting the conclusion of this article is available on request to the corresponding author. Competing interests The authors declare that they have no competing interests. Funding No funds were received in support of this work. Authors' contributions GL and DJH designed the study. SCZ performed the study and analyzed the data. YB and HSW wrote the manuscript. SCZ provided the expert consultations and clinical suggestions. SCZ, YB, JPD, YL, HSW, JMW and LG conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors reviewed the final version of the manuscript. Acknowledgements Not applicable. 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Incidental bilateral calcaneal fractures following overground walking with a wearable robotic exoskeleton in a wheelchair user with a chronic spinal cord injury: is zero risk possible? Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2020 May;31(5):1007-11. PubMed PMID: 31932962. Epub 2020/01/15. eng. Mao JZ, Agyei JO, Khan A, Hess RM, Jowdy PK, Mullin JP, et al. Technologic Evolution of Navigation and Robotics in Spine Surgery: A Historical Perspective. World neurosurgery. 2021 Jan;145:159-67. PubMed PMID: 32916361. Epub 2020/09/12. eng. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-885390","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":55131849,"identity":"d862798b-af93-475f-b534-ebb6497c18e1","order_by":0,"name":"Songchuan Zhao","email":"","orcid":"","institution":"The Honghui-Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Songchuan","middleName":"","lastName":"Zhao","suffix":""},{"id":55131850,"identity":"48cec977-370c-4d69-8f0d-597fd673f112","order_by":1,"name":"Yang Bo","email":"","orcid":"","institution":"The Honghui-Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Bo","suffix":""},{"id":55131851,"identity":"25577c1b-dcf8-463c-b996-d5ca1930dc68","order_by":2,"name":"Jinpeng Du","email":"","orcid":"","institution":"The Honghui-Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Jinpeng","middleName":"","lastName":"Du","suffix":""},{"id":55131859,"identity":"7fa058b8-f723-495c-9cda-af23b020e62c","order_by":3,"name":"Liang Yan","email":"","orcid":"","institution":"The Honghui-Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Yan","suffix":""},{"id":55131852,"identity":"2ca6b77a-ffcf-49ab-b6a2-a1c9dbb1e737","order_by":4,"name":"Dingjun Hao","email":"","orcid":"","institution":"The Honghui-Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Dingjun","middleName":"","lastName":"Hao","suffix":""},{"id":55131853,"identity":"821f8eb2-cf59-4833-8d59-5937e8fcef5b","order_by":5,"name":"Haosheng Wang","email":"","orcid":"","institution":"The Second Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Haosheng","middleName":"","lastName":"Wang","suffix":""},{"id":55131855,"identity":"219b929a-a871-4474-bfd7-50ba7cbe6994","order_by":6,"name":"Jianmin Wei","email":"","orcid":"","institution":"Baoji City Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jianmin","middleName":"","lastName":"Wei","suffix":""},{"id":55131857,"identity":"c9dff7e7-ff11-4ce0-8705-5f2545b31e5b","order_by":7,"name":"Lin Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYHACxgMJYDqxgQHIkGNjbz5AUA+KFmM+nmMJhLVAKKjGeRI5CniVy7sfPnDg4Q6GaH725MYPD3fYpLcx5DAw/KjYhlOL4Zm0hAOJZxhyZ/Y8bJZIPJOW28Zw9gBjz5nbuLU05BgcSGxjyN1wA0gmth3ObWPsS2BmbMOjpf8NRMt+iJb/6WzMPAZ4tchLwGyRAGs5kMDGRkCLgcSzBLCWGWdAfmlLNmzjYUs4iM8v8v3JBx/+BGrpb09/+PFnm528/PzHBx/8qMBjywEw9R9V9ABO9SBbGvDJjoJRMApGwSgAAQDSr19GZF7cyAAAAABJRU5ErkJggg==","orcid":"","institution":"The Honghui-Hospital, Xi’an Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Lin","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2021-09-08 06:14:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-885390/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-885390/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":14201188,"identity":"f2f9df57-7982-421d-a3df-192e77058fb8","added_by":"auto","created_at":"2021-10-01 18:27:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20491331,"visible":true,"origin":"","legend":"(A): Surgical wokflow of the Tinavi robot system assiatance; (B) Preoperative CT of the type Ⅱ odontoid fractures; (C) The guide needle insertion point, direction and the specification of screw are planned according to Intraoperative reconstructed 3D image in the odontoid axis, sagittal, and coronal positions; (D) The guide needle is inserted under the guidance of the robot arm and verified; (E) Postoperative CT showed good reduction of fracture and good screw position","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-885390/v1/70b9280e61c0f52e5d7719df.png"},{"id":14201187,"identity":"c092c873-03fe-47d6-be9c-97c547cdcffe","added_by":"auto","created_at":"2021-10-01 18:27:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":42249,"visible":true,"origin":"","legend":"There is a significant difference in the cervical spine range of motion score before and after surgery. 2-5 points before surgery, with an average of 3.43 points, 3 days after surgery, cervical motion score was 1-2 points, with an average of 1.43 points.","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-885390/v1/e58d4118faee39de2ff78f8c.png"},{"id":18501494,"identity":"b77e5d29-9b65-4640-a2e6-9c22048779a1","added_by":"auto","created_at":"2022-02-23 01:14:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1418170,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-885390/v1/59713923-c8de-4f0c-936f-4b35ddf2b73f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRobot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAnterior odontoid screw fixation is the preferred surgical method for the type II odontoid fractures as for as it can preserve the range of motion of the atlantoaxial joint(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). More and more scholars advocate the treatment of type II odontoid fractures with fixed surgery within first stage(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, due to the high difficulty of the operation and the complex anatomical structure of the upper cervical spine, the clinical application of anterior odontoid screw fixation is limited. Even though surgeons who under high doses of radiation may still be impossible to safely and accurately complete the anterior screw insertion(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The surgical robot system has many characteristics such as high operation accuracy, good operation repeatability, excellent surgical stability, less traumatic surgery, in addition, it\u0026rsquo;s worth noting that surgeons are exposed to less radiation, meanwhile, its application in upper cervical spine surgery has get more and more attention and research from clinicians(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTinavi orthopedic robot system is the world's first surgical robot that combines computer-aided navigation, real-time optical tracking and robotic arm technology(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), which is based on intraoperative three-dimensional (3-D) images (Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Tinavi orthopedic robot system has three components: navigation design system, optical tracking system and robotic arm system(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The actual workflow is as follows: first, clinicians apply the 3-D C-arm (Siemens Medical Solutions, Erlangen, Germany) to acquire a set of intraoperative images. Due to the need for high-precision calculations on the computer, the 5 positioning points on the positioning ruler must be included in the 3-D C-arm scan range. Then the clinician upload the image to the robot workstation,and design the screw entry point, screw insertion trajectory and screw specifications in the workstation according to the intraoperative 3-D images. The optical tracking system consists of an infrared stereo camera and two tracers. One tracer is fixed on the patient\u0026rsquo;s spinous process or skin, and the other is fixed on the end of the robotic arm. This enables the optical tracking system to locate the robotic arm and the patient, it also could guide the robotic arm to the planned surgical location. The robotic arm can cover all spine parts. Under the guidance of navigation design and optical tracking system, the robotic arm automatically moves to the desired position accurately(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The author has treated 7 cases of type Ⅱ odontoid fractures with anterior odontoid screw internal fixation under the navigation of Tinavi orthopedic robot from May 2018 to May 2019 (Demographic data and general clinical information of seven patients, Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data and general clinical information of seven patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eDemographic data and general clinical information of seven patients\u003c/p\u003e \u003cp\u003e\u003cem\u003eM male,F female\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCause of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003etraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003efalling injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003etraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003efalling injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003etraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperation time(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e103.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraoperative blood loss(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRampersaud score(A-D grade)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain VAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture healing time(week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eGeneral information Inclusion criteria: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) Type II odontoid fracture, mild to moderate displacement ; (2) Without nerve or vertebral artery injury; (3) 18-70 years old. Exclusion criteria: (1) Combined with severe medical disease or multiple injuries and unable to tolerate surgery; (2) Combined with nerve/vascular injury requiring open surgical exploration and decompression; (3) Lost to follow-up within three months after surgery. Include 7 cases, 5 males and 2 females, aged 29-63 years old, average 42.7 years old. Causes of injury: 5 cases were injured by car accidents, 2 cases were injured by falling from height; 3 cases had limb fractures, 2 cases had closed chest injuries, and 2 cases had only neck pain and limited mobility. Before surgery, all patients had completed 64-slice CT scans and 3-D reconstructions, and performed MRI examinations to understand type Ⅱ odontoid fractures, soft tissue injuries and vertebral artery heights.\u003c/p\u003e\n\u003cp\u003eOperation method: General anesthesia, take the supine position, fix the patient\u0026apos;s head on the Mayfeild head frame, confirm the fracture reduction under the C-arm X-ray machine, and connect the robot parts and accessories, including the mechanical arm, surgical planning and navigation system, and optical positioning Tracking system and 3-D C-arm. Intraoperative CT scan to obtain 3D images: send the images to the dimensity Robot Surgery Planning and Navigation System. The assistant calls up the reconstructed image on the planning workbench, and plans the needle insertion point and needle direction in the odontoid axis, sagittal, and coronal positions, so that the guide needle passes through the main fracture line, confirm it not breached the bone cortex, and the mechanical arm is moved to simulate the running track. Measure the diameter and length of the required dentate screw. The guide needle is inserted under the guidance of the robot arm and verified. The robot arm is operated according to the predetermined trajectory, so that the tip of the guide needle sleeve on the robot arm slightly touches the bone at the needle insertion point, and the power drill is inserted under the guide of the sleeve Guide needle, confirm the position and insertion depth of the guide needle under fluoroscopy; Measure the diameter and length of the required dentate screw. The guide needle is inserted under the guidance of the robot arm and verified. The robot arm is operated according to the predetermined trajectory, so that the tip of the guide needle sleeve on the robot arm slightly touches the bone at the needle insertion point, and the power drill is inserted under the guide of the sleeve Guide needle, confirm the position and insertion depth of the guide needle under fluoroscopy.\u003c/p\u003e\n\u003cp\u003ePostoperative treatment and follow-up: Antibacterial drugs were routinely used within 24 hours after surgery. Patients were encouraged to wear a cervical collar to protect them from getting out of bed on the first day after surgery. Cervical X-rays and CT scans were reviewed 3 days after surgery. The neck brace was removed after 4 weeks, and active neck exercises were started. Regular follow-ups were performed after the operation, and the cervical spine was taken in front and side view and dynamic position, and CT thin-layer scanning was performed to evaluate the stability of the cervical spine and fracture healing. Six months after surgery, the Mayor scoring system after cervical spine trauma was used to evaluate the patient\u0026apos;s functional recovery.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll 7 patients in this group successfully completed the operation without nerve and blood vessel damage. What is the operation time 110 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative re-examination of the cervical spine in positive and lateral and dynamic position X-rays showed that the cervical spine was stable, and there was no failure of internal fixation or fracture displacement during the follow-up. All 7 cases were followed up satisfactorily, average follow-up time 12.4 Month (6-24 month), during the follow-up period, 7 patients had no surgical related complications. Postoperative CT showed that the fractures were all healed, and the average fracture healing time was average 13.7 weeks (12-15weeks) (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Pain VAS score 0-2 points, average 0.7 points. The cervical spine range of motion is scored 2-5 points before surgery, with an average of 3.43 points, 3 days after surgery, cervical motion score was 1-2 points, with an average of 1.43 points(Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). 6 months postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eOdontoid fractures account for 15%-20% of all cervical spine fractures, and type II fractures account for 65%-74% of all odontoid fractures. Type II odontoid fractures are unstable fractures, and the rate of nonunion in conservative treatment is relatively high(\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). Anterior odontoid screw internal fixation can achieve immediate fracture fixation and it can preserve the range of motion of the atlantoaxial joint. The advantage is that it retains the rotation of the C1-C2 vertebral body, has a higher fusion rate and better clinical effects than external fixation(\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). Due to the special anatomical structure of the odontoid process and the distribution of important nerves and blood vessels around it, coupled with unstable fractures and displacement after fractures, it increased the difficulty of inserting screw under the guidance of traditional freehand fluoroscopy for surgeons(\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eOrthopedic robots can assist clinicians in intelligent surgical planning and precise intraoperative operations, effectively reduce clinicians\u0026rsquo; human errors during the operation, realize intelligent human-computer interaction, and perfectly control surgical accuracy through digital navigation throughout the process(\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). Robot-assisted screw insert technology has achieved higher accuracy than traditional barehand fluoroscopy in other positions of the spine, and can provide real-time dynamic adjustment during the operation(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). If the pedicle screw implantation deviation occurs during the operation, the orthopedic robot can also be timely. The feedback on the screen is convenient for the doctor to adjust to the preoperative setting position(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). The results of meta-analysis by Fan et al. showed that compared with hand nail placement, the proportion of robot-assisted nail placement reaching A (Gertzbein-Robbins\u0026rsquo;s classification) was higher ((odds ratio 95%, \u0026quot;perfect accuracy\u0026quot; confidence interval: 1.38-2.07, P \u0026lt; .01; odds ratio 95% \u0026quot;clinically acceptable\u0026quot; Confidence Interval: 1.17-2.08, P \u0026lt; .01).) (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). Molliqaj et al. reported that in the placement of pedicle screws, the clinical acceptance rate of robot-assisted screws was 93.4%, which was higher than 88.9% of traditional fluoroscopy(\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). Intelligent surgical planning technology is based on CT for 3D intelligent modeling, providing patients with personalized surgical plans(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). According to the patient\u0026apos;s personal situation, select the appropriate pedicle screw size, set the implant position and angle, and simulate soft tissue. The balance of the situation.\u003c/p\u003e\n\u003cp\u003eThe robot performs intelligent operation, the operation process is stable, and the operation time is shortened to 103.3 minutes, effectively reducing the amount of bleeding during the operation(11.1ml). The actual size, screw position and angle of the pedicle screw used are consistent with the preoperative plan height, reducing the possibility of surgical complications. As far as post-operative rehabilitation is concerned, it is also conducive to shorten the length of hospitalization, speed up post-operative rehabilitation, and reduce hospitalization costs(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). Especially for patients with atlantoaxial fractures, the biggest advantage of the robotic surgery system is that the pedicle screw placement is safer and more precise, the incision is smaller, the injury is less, the bleeding is less, and the patient recovers more quickly(\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). Compared with traditional treatment methods, the robot-assisted nail placement has no X-ray exposure during the entire operation. However, this study also has limitations. First of all, it is difficult to draw more reliable conclusions due to fewer cases(\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). However, the purpose of this study is to illustrate the feasibility of a new treatment method for odontoid fractures, so a small sample size can basically be Meet the needs of research. Secondly, this study did not conduct a prospective randomized controlled study of robot-assisted nail placement and other treatment methods. Therefore, it is necessary to further carry out multi-center and large-sample randomized controlled trials to further verify the results of this study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRobotic assisted laparoscopic nephropexy can be safely and effectively performed in a spinal surgery. Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMRI: magnetic resonance; CT: computed tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is based on the SEER database and does not require ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set supporting the conclusion of this article is available on request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds were received in support of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGL and DJH designed the study. SCZ performed the study and analyzed the data. YB and HSW wrote the manuscript. SCZ provided the expert consultations and clinical suggestions. SCZ, YB, JPD, YL, HSW, JMW and LG conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors reviewed the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCarvalho AD, Figueiredo J, Schroeder GD, Vaccaro AR, Rodrigues-Pinto R. Odontoid Fractures: A Critical Review of Current Management and Future Directions. Clinical spine surgery. 2019 Oct;32(8):313-23. PubMed PMID: 31464693. Epub 2019/08/30. eng.\u003c/li\u003e\n \u003cli\u003eFan L, Ou D, Huang X, Pang M, Chen XX, Yang B, et al. Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis. Medicine. 2019 Nov;98(44):e10281. PubMed PMID: 31689741. Pubmed Central PMCID: PMC6946417. Epub 2019/11/07. eng.\u003c/li\u003e\n \u003cli\u003eLee TK, Han MS, Lee SK, Moon BJ, Lee JK. Outcomes of Patients Undergoing Anterior Screw Fixation for Odontoid Fracture and Analysis of the Predictive Factors for Surgical Failure. Neurospine. 2020 Sep;17(3):603-9. PubMed PMID: 33022165. Pubmed Central PMCID: PMC7538357. Epub 2020/10/07. eng.\u003c/li\u003e\n \u003cli\u003eElswick CM, Strong MJ, Joseph JR, Saadeh Y, Oppenlander M, Park P. Robotic-Assisted Spinal Surgery: Current Generation Instrumentation and New Applications. Neurosurgery clinics of North America. 2020 Jan;31(1):103-10. PubMed PMID: 31739920. Epub 2019/11/20. eng.\u003c/li\u003e\n \u003cli\u003eMcDonnell JM, Ahern DP, T \u0026Oacute;D, Gibbons D, Rodrigues KN, Birch N, et al. Surgeon proficiency in robot-assisted spine surgery. The bone \u0026amp; joint journal. 2020 May;102-B(5):568-72. PubMed PMID: 32349598. Epub 2020/05/01. eng.\u003c/li\u003e\n \u003cli\u003eTian W. Robot-Assisted Posterior C1-2 Transarticular Screw Fixation for Atlantoaxial Instability: A Case Report. Spine. 2016 Oct;41 Suppl 19:B2-B5. PubMed PMID: 27145470. Epub 2016/05/05. eng.\u003c/li\u003e\n \u003cli\u003eDu J, Gao L, Huang D, Shan L, Wang W, Fan Y, et al. Radiological and clinical differences between robotic-assisted pedicle screw fixation with and without real-time optical tracking. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2021 Jan;30(1):142-50. PubMed PMID: 33079237. Epub 2020/10/21. eng.\u003c/li\u003e\n \u003cli\u003eWang JQ, Wang Y, Feng Y, Han W, Su YG, Liu WY, et al. Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-assisted Navigation Procedures with a Conventional Technique. Chinese medical journal. 2017 Nov 5;130(21):2527-34. PubMed PMID: 29067950. Pubmed Central PMCID: PMC5678249. Epub 2017/10/27. eng.\u003c/li\u003e\n \u003cli\u003ePei B, Zhu G, Wang Y, Qiao H, Chen X, Wang B, et al. The development and error analysis of a kinematic parameters based spatial positioning method for an orthopedic navigation robot system. The international journal of medical robotics + computer assisted surgery : MRCAS. 2017 Sep;13(3). PubMed PMID: 27723229. Epub 2016/10/11. eng.\u003c/li\u003e\n \u003cli\u003eLvov I, Grin A, Talypov A, Godkov I, Kordonskiy A, Khushnazarov U, et al. The impact of odontoid screw fixation techniques on screw-related complications and fusion rates: a systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2021 Feb;30(2):475-97. PubMed PMID: 32556628. Epub 2020/06/20. eng.\u003c/li\u003e\n \u003cli\u003eFeng G, Wendlandt R, Spuck S, Schulz AP. One-screw fixation provides similar stability to that of two-screw fixation for type II dens fractures. Clinical orthopaedics and related research. 2012 Jul;470(7):2021-8. PubMed PMID: 22585352. Pubmed Central PMCID: PMC3369094. Epub 2012/05/16. eng.\u003c/li\u003e\n \u003cli\u003eYuan S, Wei B, Tian Y, Yan J, Xu W, Wang L, et al. The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1-2 without fusion: a retrospective cohort study. Journal of orthopaedic surgery and research. 2018 Jan 8;13(1):3. PubMed PMID: 29310670. Pubmed Central PMCID: PMC5759802. Epub 2018/01/10. eng.\u003c/li\u003e\n \u003cli\u003eTian W, Liu YJ, Liu B, He D, Wu JY, Han XG, et al. Guideline for Thoracolumbar Pedicle Screw Placement Assisted by Orthopaedic Surgical Robot. Orthopaedic surgery. 2019 Apr;11(2):153-9. PubMed PMID: 31025807. Pubmed Central PMCID: PMC6594520. Epub 2019/04/27. eng.\u003c/li\u003e\n \u003cli\u003ePeng YN, Tsai LC, Hsu HC, Kao CH. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Annals of translational medicine. 2020 Jul;8(13):824. PubMed PMID: 32793669. Pubmed Central PMCID: PMC7396236. Epub 2020/08/15. eng.\u003c/li\u003e\n \u003cli\u003eFan Y, Du JP, Liu JJ, Zhang JN, Qiao HH, Liu SC, et al. Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: An updated meta-analysis. Medicine. 2018 Jun;97(22):e10970. PubMed PMID: 29851848. Pubmed Central PMCID: PMC6392558. Epub 2018/06/01. eng.\u003c/li\u003e\n \u003cli\u003eMolliqaj G, Schatlo B, Alaid A, Solomiichuk V, Rohde V, Schaller K, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurgical focus. 2017 May;42(5):E14. PubMed PMID: 28463623. Epub 2017/05/04. eng.\u003c/li\u003e\n \u003cli\u003ePennington Z, Cottrill E, Westbroek EM, Goodwin ML, Lubelski D, Ahmed AK, et al. Evaluation of surgeon and patient radiation exposure by imaging technology in patients undergoing thoracolumbar fusion: systematic review of the literature. The spine journal : official journal of the North American Spine Society. 2019 Aug;19(8):1397-411. PubMed PMID: 30974238. Epub 2019/04/12. eng.\u003c/li\u003e\n \u003cli\u003eHanna G, Kim TT, Uddin SA, Ross L, Johnson JP. Video-assisted thoracoscopic image-guided spine surgery: evolution of 19 years of experience, from endoscopy to fully integrated 3D navigation. Neurosurgical focus. 2021 Jan;50(1):E8. PubMed PMID: 33386009. Epub 2021/01/02. eng.\u003c/li\u003e\n \u003cli\u003eBass A, Morin SN, Vermette M, Aubertin-Leheudre M, Gagnon DH. Incidental bilateral calcaneal fractures following overground walking with a wearable robotic exoskeleton in a wheelchair user with a chronic spinal cord injury: is zero risk possible? Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2020 May;31(5):1007-11. PubMed PMID: 31932962. Epub 2020/01/15. eng.\u003c/li\u003e\n \u003cli\u003eMao JZ, Agyei JO, Khan A, Hess RM, Jowdy PK, Mullin JP, et al. Technologic Evolution of Navigation and Robotics in Spine Surgery: A Historical Perspective. World neurosurgery. 2021 Jan;145:159-67. PubMed PMID: 32916361. Epub 2020/09/12. eng.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tinavi Robot, Type Ⅱ odontoid fractures, Screw fixation","lastPublishedDoi":"10.21203/rs.3.rs-885390/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-885390/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAnterior odontoid screw fixation is considered to be preferred surgical treatment for the type Ⅱ odontoid fractures. However, due to the high difficulty to insert odontoid screw with barehand, the high risk of screw misalignment and damage to surrounding important tissue structures, we urgently need robot-assisted screw insert navigation technology to improve the safety and accuracy of inserting odontoid screws.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We retrospectively analyzed 7 patients with type II odontoid fractures who underwent Tinavi robot-assisted screw insert technology from May 2018 to May 2019 at our hospital. All patients had received 64-row CT scans and 3D reconstructions completed preoperatively, and magnetic resonance (MRI) were performed to verify the severity of odontoid fractures, soft tissue injuries and vertebral artery height. Postoperative CT was repeated in 6 months after surgery to evaluate cervical stability and confirm whether the screw had breached the bone cortex, the accuracy of screw placement based on Rampersaud A-D grade. Functional recovery was assessed using the post-traumatic Mayor scoring system for the cervical spine.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e All 7 patients successfully completed the robot-assisted operation without nerve and blood vessel damage. What is the operation time 103.3 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative CT of these 7 patients showed that the cervical spine was stable, the accuracy of “perfect” and “clinically acceptable” odontoid screw implantation was 100% (7/7), none of the seven odontoid screws breached the bone cortex. Reexamination of X-rays showed that the fractures were all healed, and the average fracture healing time was average 13.7weeks (12-15weeks). During the follow-up period, 7 patients had no surgical complications, postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures.\u003c/p\u003e","manuscriptTitle":"Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-10-01 18:27:54","doi":"10.21203/rs.3.rs-885390/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"784775f6-b539-4167-a99f-19bc1938a161","owner":[],"postedDate":"October 1st, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":7595272,"name":"Orthopedics"}],"tags":[],"updatedAt":"2022-02-23T01:14:05+00:00","versionOfRecord":[],"versionCreatedAt":"2021-10-01 18:27:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-885390","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-885390","identity":"rs-885390","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}