Transarticular screw C1-C2 fixation: Minimal invasive with percutaneous screw placement

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Abstract

Transarticular (TA) screws of the atlantoaxial joint can be used as a primary technique for posterior C1-C2 stabilization, as popularized by Magerl. In this chapter, we review the surgical technique for posterior C1-C2 TA screw fixation in cases of atlantoaxial instability. Our preference is to use image guidance with 3D fluoroscopic navigation over 2D fluoroscopic techniques if available. We describe how a posterior exposure of the C1 and C2 posterior elements can be combined with a percutaneous transmuscular TA screw placement, thus allowing a very steep TA screw trajectory without having an extensive soft tissue exposure extending down to the upper thoracic spine. Such a procedure achieves immediate stability similar to that obtained in C1 lateral mass and C2 pedicle screws. TA screw fixation is technically demanding and is associated with a steep learning curve, so full anatomical knowledge is essential.

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Coll, J. B., & Duff, J. M. (2019). Transarticular screw C1-C2 fixation: Minimal invasive with percutaneous screw placement. In Cervical Spine Surgery: Standard and Advanced Techniques: Cervical Spine Research Society - Europe Instructional Surgical Atlas (pp. 245–251). Springer International Publishing. https://doi.org/10.1007/978-3-319-93432-7_37

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