Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Rigid screw fixation of the axis (C2) is crucial for atlantoaxial and subaxial cervical constructs, offering stability and fusion.
• Traditional methods like transarticular C1-C2 screws are limited by anatomical variations and vertebral artery injury risk.
• C2 pedicle screws, while an improvement, still carry a significant risk to the vertebral artery.

Observation:

• Anatomic variability in the foramen transversarium affects up to 20% of patients, complicating safe C1-C2 screw placement.
• The described technique utilizes bilateral, crossing C2 laminar screws for rigid fixation.
• This novel approach avoids direct risk to the vertebral artery during C2 fixation.

Findings:

• The novel C2 laminar screw technique has been successfully applied in 10 patients.
• Indications included trauma, neoplasm, pseudarthrosis, and degenerative disease.
• The technique demonstrated efficacy in craniocervical, atlantoaxial, and subaxial fixation.

Implications:

• This technique offers a safer alternative for C2 rigid screw fixation, mitigating vertebral artery injury.
• It expands fixation options for complex cervical spine conditions.
• Further research may validate the long-term advantages of C2 laminar screws in spinal fusion.