Abstract
BACKGROUND: The optimal treatment strategy for atlantoaxial fracture-dislocation remains a focal point of clinical research and a subject of ongoing debate, with a paucity of definitive comparative clinical studies. OBJECTIVE: With the increasing application of robot-assisted (RA) technology in spinal surgery, the present study aims to compare the clinical efficacy of traditional fluoroscopy-assisted freehand screw placement (FA) and robot-assisted screw placement in the treatment of atlantoaxial fracture-dislocation, providing a reference for clinical practice. METHODS: This retrospective study analyzed the clinical data of 59 patients with atlantoaxial fracture-dislocation who underwent surgical treatment at Honghui Hospital in Xi'an from May 2023 to August 2024. Patients were divided into two groups based on the method of screw placement: the freehand group (n = 36) and the robot-assisted group (n = 23). Data on surgical time, intraoperative blood loss, postoperative hospital stay, and the incidence of complications, such as vascular, neural, and spinal cord injuries were collected. The accuracy of pedicle screw placement was evaluated using the Gertzbein and Robbins scoring system. Treatment outcomes were assessed using visual analog scale (VAS) scores for pain, Japanese Orthopaedic Association (JOA) scores for cervical spine function, and the incidence of postoperative complications. RESULTS: All 59 patients successfully underwent surgery, with significant postoperative improvement in symptoms. The study results demonstrated that the robotic-assisted group had significantly longer operative times (171.1 ± 23.6 min) and higher intraoperative blood loss (305.9 ± 53.7 ml) compared with the manual group (operative time: 109.9 ± 18.5 min; intraoperative blood loss: 185.0 ± 21.2 ml), with statistically significant differences between the two groups (P < 0.01). However, the robotic-assisted group exhibited significantly higher accuracy and safety in screw placement (96.5%) compared with the manual group (87.4%), and the postoperative hospital stay was significantly shorter in the robotic-assisted group (4.3 ± 1.0 days) than in the manual group (6.3 ± 1.2 days), with statistically significant differences between the two groups (P < 0.01). Moreover, at the final follow-up, the Visual Analog Scale (VAS) scores and Cervical Japanese Orthopaedic Association (JOA) scores of all patients had significantly improved compared with preoperative values (P < 0.05). CONCLUSION: In the treatment of atlantoaxial fracture-dislocation, robot-assisted techniques offer significant advantages in terms of screw placement accuracy and safety compared with traditional freehand methods, and effectively reduce postoperative hospital stay duration. These findings suggest that robot-assisted technology holds great promise for complex spinal surgeries and is worthy of further promotion and application in clinical practice.