C2 pars screw insertion

1. Introduction

Pars screws in C2 may be used in the management of trauma, tumors, and degenerative conditions in the cervical spine.

Pars screw insertion in C2 vertebra for treating trauma, tumors, or degeneration in cervical spine

2. C2 pedicle screw vs pars screw

When only a C1–C2 arthrodesis is done, a C2 pedicle screw is preferred to a C2 pars screw. This is because the pars screw starting hole is more distal and therefore requires more muscle dissection. But, if a C2 pedicle screw is not possible, a C2 pars screw can be used.

C2 pars screw insertion shown; used when pedicle screw isn't feasible in C1–C2 arthrodesis procedures

3. Preoperative evaluation

A preoperative CT image must be evaluated to determine if a C2 pars screw can be used. Some patients have a pars that is too small to accept such a screw.

4. Screw entry point

The starting point of the C2 pars screw is 3–4 mm cranial to the C2–C3 facet joint and in the midpoint of the pars mediolaterally.

Make a small burr hole as the starting point for the transarticular screw.

C2 pars screw start point is 3–4 mm above C2–C3 facet, centered mediolaterally on the pars

5. Screw trajectory

The trajectory should be as dorsal as possible without perforating the dorsal cortex of the C2 pars.

C2 pars screw trajectory is dorsal, avoiding perforation of the dorsal cortex of the C2 pars

6. Screw insertion

Tap, measure the length, and place the screw. Typically, a unicortical screw that is longer than 16 mm is adequate.

Tap, measure, and insert a unicortical C2 pars screw, typically longer than 16 mm for stability
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