C1-2 Fixation Approach for Patients With Vascular Irregularities: A Case Report

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spine Surgery

Background:

• Posterior spinal fusion (PSF) at the C1-2 level carries a risk of vertebral artery injury.
• The C2 pedicle is a common screw placement site, but anatomical variations can increase risk.
• Alternative fixation methods are needed for complex C1-2 anatomy.

Purpose of the Study:

• To evaluate the safety and efficacy of C2 laminar screws as an alternative fixation in PSF.
• To address challenges posed by vertebral artery migration during C1-2 fusion.

Main Methods:

• A case report of a 67-year-old male undergoing PSF for C1-2 degeneration.
• Preoperative imaging revealed an enlarged left vertebral artery with midline migration into the C2 body.
• A C2 laminar screw was used on the left to avoid the vertebral artery.

Main Results:

• The C2 laminar screw placement successfully avoided the anomalous vertebral artery.
• The patient underwent uncomplicated PSF and recovery.
• This demonstrates the feasibility of C2 laminar screws in challenging anatomy.

Conclusions:

• C2 laminar screws are a viable alternative to C2 pedicle screws in PSF.
• This technique mitigates the risk of vertebral artery injury in cases of anatomical variation.
• It expands surgical options for complex C1-2 posterior spinal fusion.