Surgical Techniques: Upper Cervical—C2 Pedicle Screw Fixation Technique
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Cervical pedicle screw fixation reliably stabilises unstable motion segments that are caused by either traumatic or nontraumatic lesions. C2 pedicle insertion, guided directly by the medial and superior aspect of the C2 pedicle, may be performed more safely than pedicle screw fixation in the middle and lower cervical spine. The direction is approximately 15 to 20° medially in the horizontal plane and perpendicular to the anterior surface of the axis. Preoperative imaging studies include computed tomography (CT) and three-dimensional CT angiography (3D-CTA) to view bony anatomy and determine the precise location of the vertebral arteries (VAs) and surrounding bony structures, respectively. A 3D-CTA-based surgical planning algorithm is useful for viewing the different types of vascular anomalies. However, there are limitations to placing pedicle screws in the cervical spine because of anatomical variations of the pedicle and VAs.
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