Transarticular Screw C1-C2 Fixation: Minimal Invasive with Percutaneous Screw Placement
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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