Robotic-Assisted C2 Laminar Screw Placement: Initial Experience and Accuracy Evaluation.

Abstract

Background: The anchor at C2 often serves as a key stabilizer in cervical spine fusion surgery. Although the pedicle screw is considered the standard fixation method at C2, the laminar screw is also a widely used alternative due to its biomechanical stability, comparable to that of C2 PS. However, malpositioning of C2 LS carries a risk of neural injury and compromised fixation stability, and the use of surgical assistance has been reported to improve placement accuracy. The robotic system is a relatively new technology for PS placement, and its application has recently expanded to the cervical spine. The present study aimed to investigate the accuracy of C2 laminar screw placement with robot assistance.

Methods: This prospective study evaluated 11 C2 laminar screws in 11 patients who underwent cervical fusion surgery with the robot assistance between March 2024 and June 2025.

Results: All 11 C2 laminar screws were successfully placed with no cortical breaches and no screw-related complications. The mean deviations at both the entry point and at a depth of 20 mm were less than 1.0 mm in both the axial and sagittal planes.

Conclusions: The results of this study suggest that the robotic system is a potential tool to facilitate accurate C2 laminar screw placement in clinical settings.