Authors of section

Authors

Ronald Lehman, Daniel Riew, Klaus Schnake

General Editor

Luiz Vialle

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Anterior C1-C2 trans articular screws

1. Introduction

The advantage of this screw is that it requires less muscle dissection than a posterior trans articular screw. The disadvantage is that, in order to perform a fusion, a transoral approach to decorticate the C1-C2 joint is usually necessary. Because of this, this is the least popular C1-C2 fixation technique.

anterior c1 c2 trans articular screws

2. Preoperative evaluation

A preoperative CT image must be evaluated to determine if this screw is possible.

3. Approach

A standard Smith Robinson approach to the cervical spine is utilized for the insertion of anterior trans articular C1-C2 screws.

anterior c1 c2 trans articular screws

The incision is made as if approaching a C4-C5 anterior cervical discectomy and fusion. The dissection is carried out cranially until C2 is exposed. A curved Deaver retractor is helpful.

anterior c1 c2 trans articular screws

4. Screw entry point

The starting hole for the screw is 7-8 mm distal to the C1-C2 joint.

It is 3-5 mm lateral to the medial border of the C1-C2 joint.

anterior c1 c2 trans articular screws

5. Screw trajectory

It is directed approximately 30° laterally and 30° posteriorly across the joint.

anterior c1 c2 trans articular screws

6. Screw insertion

Drill, tap, measure and insert the screw under fluoroscopic guidance. The screw should not perforate the dorsal cortex of C1, nor should it violate the occipital cervical joint.

anterior c1 c2 trans articular screws