Rationale:The typical intraoperative presentation of vertebral artery injury (VAI) usually involves profuse bleeding and requires immediate treatment. However, an occult VAI may occur intraoperatively and result in delayed life-threatening epidural pseudoaneurysm several days postoperatively.Patient concerns:A 21-year-old man with compressive cervical myelopathy resulting from canal stenosis of skeletal fluorosis underwent decompression of C1 to C7 and instrumentation from C2 to C7. No impressive bleeding event occurred during the operation. On postoperative day 40, progressive quadriplegia developed.Diagnoses:Pseudoaneurysm of the VA was established by angiography.Interventions:After occlusion of the right VA, the patient underwent hematoma clearing.Outcomes:Fortunately, the patient experienced significant recovery of neurologic function after the second surgery.Lessons:From this case, we realize even in the absence of obvious signs of VAI during a cervical operation, postoperative evaluation should be mandatory for suspected bleeding events occurring at VAI-prone sites during surgery. Moreover, the bone morphological abnormality of skeletal fluorosis was determined to be the most important risk contributing to VAI in this case. The safety limits of bone removal should be determined preoperatively to avoid the effects of bone morphological abnormalities.
The traditional spinal surgery is often conducted by hand operation with the help of navigation system which is combined with medical image. Although a veteran surgeon has a good adaptability during surgeries, it will tend to decrease along with the increase in surgery time which causes fatigues and leads to low qualities. Many surgical robots have been developed to assist surgeons in operation, and some of them approved by doctors or researchers are DaVinci (Intuitive Surgical, America) [1], Renaissance (Mazor Robotics, Israel), etc. These robot systems have enhanced the accuracy of operation; however, the adaptabilities are still weakened at the same time. During the pedicle screw drilling, surgeons can well adapt to the spine movements mainly caused by respiration, while it is difficult for these robots to adapt to the movements, indicating that the accuracy might drop in the actual application.
Respiratory compensation system is aimed to keep the region of operation stable or reduce the amplitude of fluctuation [2]. The rests of paper introduced the respiratory compensation system and its control algorithm based on infrared tracking data, and experiments were conducted to analyze the accuracy and stability.
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