Real-Time Image-Guided Robotic-Assisted Repair of Spinal Instability in a Patient with Thoracolumbar Trauma

The patient is a 23-year-old woman with no significant past medical history, who sustained a flexion-distraction injury from a high-speed motor vehicle collision resulting in an L1 Chance fracture without any neurologic deficits. The Thoracolumbar Injury Classification and Severity Scale score comprises assessments of injury morphology, the integrity of the posterior ligamentous complex, and the presence of neurological injury. A score over 4 suggests that the patient may be an operative candidate, as it confirms spinal instability and indicates a role for surgical intervention. The surgical goals and anatomical challenges of this case made it ideal for a minimally invasive robotic approach. The intraoperative CT fixture was then affixed to the clamp and the intraoperative CT scanner was brought into the room. A three-dimensional CT scan of the thoracolumbar junction was obtained and the dataset was transferred to the robot. Point-to-point anatomical accuracy, verification, and registration were undertaken for real-time image guidance.