Intraoperative computed tomography guided navigation for atlantoaxial screw placement: Accuracy and safety analysis

Atlantoaxial stabilization is indicated for traumatic or degenerative pathologies. The procedure is technically demanding due to delicate neurovascular anatomy and narrow bone corridors. Recent technologies such as neuronavigation and intraoperative computed tomography (iCT) may improve screw placement and reduce complications. This study reports our experience with C1-C2 stabilization using these tools.

This retrospective single-center study included 15 consecutive patients who underwent C1-C2 stabilization. Clinical assessment was performed pre- and postoperatively using the Neck Disability Index and American Spinal Injury Association score. Fractures were classified using standard parameters; degenerative cases were assessed with positional magnetic resonance imaging. Other data collected included pathology, surgical technique, sagittal/coronal alignment, complications, and follow-up duration. All surgeries used iCT for navigation and intraoperative control. Screw accuracy was assessed with a modified Gertzbein-Robbins scale.

Mean patient age was 63 years. Indications were traumatic (47%) or degenerative (53%). Screws were placed into C1-C2 lateral masses. Of 60 screws, 54 were grade A and 6 were grade B. One case required recalibration due to neuronavigation inaccuracy. Alignment was restored in all cases. Thirteen patients showed significant clinical improvement. Mean follow-up was 12 months, with no complications recorded.

Neuronavigation with iCT for C1-C2 screw placement proved safe and accurate. Our data show 90% grade A and 10% grade B screws, with a mean deviation of 0.13 mm and no intra-or postoperative complications attributable to the technique.