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Posterior arch C-1 screw technique: a cadaveric comparison study.

Marc Moisi1,2, Christian Fisahn1,3, Lara Tkachenko2

  • 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington.

Journal of Neurosurgery. Spine
|March 18, 2017
PubMed
Summary

The posterior arch lateral mass (PALM) technique for C-1 screw placement offers superior C-2 nerve root protection compared to the conventional Goel/Harms lateral mass (GHLM) technique. PALM demonstrated significantly fewer medial screw penetrations, enhancing safety in atlantoaxial stabilization.

Keywords:
C-1GHLM = Goel/Harms C-1 lateral massPALM = posterior arch lateral masscervicallateral mass screwposterior arch lateral mass

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Area of Science:

  • Neurosurgery
  • Spine Surgery
  • Orthopedic Surgery

Background:

  • Posterior atlantoaxial stabilization frequently utilizes C-1 lateral mass screw fixation.
  • Conventional Goel/Harms lateral mass (GHLM) screw placement carries risks due to proximity to the C-2 nerve root and other vital structures.
  • An alternative posterior arch lateral mass (PALM) technique may offer improved safety and control.

Purpose of the Study:

  • To compare the safety and accuracy of the PALM technique versus the GHLM technique for C-1 screw placement.
  • To specifically assess the risk of C-2 nerve root impingement with each technique.

Main Methods:

  • A cadaveric study involving 17 human specimens.
  • Spine fellows performed GHLM on the left and PALM on the right under fluoroscopic guidance.
  • CT scans evaluated screw placement accuracy, and blinded faculty graded screw quality using a modified Upendra classification.

Main Results:

  • The C-2 nerve root was impinged in 76.5% of specimens.
  • The GHLM technique resulted in acceptable (Type 1 or 2) placement in 70.6% of cases, versus unacceptable (Type 3 or 4) in 29.4%.
  • The PALM technique achieved acceptable placement in 100% of cases (p = 0.015), with no vertebral artery injuries and fewer medial penetrations.

Conclusions:

  • The PALM technique demonstrated statistically fewer medial screw penetrations compared to the GHLM technique.
  • The PALM technique offers a potentially safer alternative for C-1 screw placement, minimizing C-2 nerve root risk.
  • Further investigation into the reasons for improved trajectory control with PALM is warranted.