Surgical Technique: Posterior Subaxial Cervical Spine, Subaxial Transarticular Screw Fixation

Abstract

Posterior cervical fixation is mainly utilized for either fusion or stabilization for a number of etiologies, including degenerative, deformity, trauma, and neoplastic process. While lateral mass screw fixation is the standard mainstay, one must be prepared for salvage technique in the face of failed traditional screw attempt or inadequate bony anatomy. Transarticular screw fixation in the subaxial spine allows for a biomechanically equivalent stabilization method and provides less room for error. This fixation can also be incorporated to traditional lateral mass screw-rod constructs if planned correctly. This chapter will provide a step-by-step approach to placement of these screws, with a particular focus on the technical nuances to provide four-cortex fixation, as well as “tulip management” for proper incorporation into screw-rod constructs.