Freehand C1 lateral mass screw fixation technique: our experience

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• C1 lateral mass fixation is common for upper cervical instability but relies on fluoroscopy.
• Fluoroscopy guidance is time-consuming, poses radiation risks, and is challenging with cranial fixations.
• This study explored a fluoroscopy-free approach for C1 lateral mass screw insertion.

Purpose of the Study:

• To demonstrate the safety and speed of unicortical C1 lateral mass screw placement without fluoroscopy.
• To evaluate the feasibility of this technique in various upper cervical instability cases.

Main Methods:

• 32 unicortical C1 lateral mass screws were inserted in 17 patients between 2002 and 2008.
• Patients had conditions involving atlantoaxial or occipitocervical instability.
• Screw lengths varied from 18 to 32 mm; some cases required C1 pedicle screw analogs.

Main Results:

• No screw malpositions or neurovascular complications were observed.
• No screw loosening or construct failure occurred during a mean follow-up of 32.3 months.
• Minor postoperative complications included hypoesthesia in 4 patients and a superficial wound infection in one.

Conclusions:

• Unicortical C1 lateral mass screws can be safely and rapidly inserted in upper cervical instabilities without intraoperative fluoroscopy or spinal navigation.
• Meticulous preoperative planning, including determining ideal screw trajectory and length, is paramount for success.