C2 Screw fixation techniques in atlantoaxial instability: A technical review

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Atlantoaxial instability (AAI) presents significant surgical challenges due to its anatomical location near critical neurovascular structures.
• C1-C2 fusion is a well-established surgical standard for managing AAI.
• Optimal C2 screw fixation is crucial for the success of C1-C2 fusion in AAI.

Purpose of the Study:

• To provide a comprehensive overview of current C2 screw fixation techniques used in AAI surgery.
• To analyze the technical nuances and biomechanical properties of each described C2 screw fixation method.
• To enhance understanding of surgical options for C1-C2 fusion in AAI.

Main Methods:

• Review of common C2 screw fixation techniques: C2 pedicle, C2 pars, C2 translaminar, C2 subfacetal, C2-C3 transfacetal, and C2 inferior facet screw.
• Detailed discussion of the technical aspects and surgical considerations for each method.
• Analysis of the biomechanical principles underlying the stability provided by each fixation technique.

Main Results:

• Identification and description of six primary C2 screw fixation techniques for AAI.
• Elucidation of the specific anatomical landmarks, screw trajectories, and potential risks associated with each technique.
• Comparative insights into the biomechanical advantages and limitations of different C2 fixation methods.

Conclusions:

• A thorough understanding of various C2 screw fixation techniques is essential for neurosurgeons and orthopedic spine surgeons managing AAI.
• Each technique offers distinct advantages and disadvantages regarding technical feasibility, biomechanical stability, and potential complications.
• This review serves as a guide to selecting the most appropriate C2 fixation strategy based on individual patient anatomy and surgical goals.