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C1 Posterior Arch Screw Fixation

  • Jin S. Yeom
Chapter

Abstract

C1 posterior arch screw has several advantages over conventional lateral mass screw. The author places the screw using his own freehand technique without fluoroscopic guidance. The screw entry point is determined by inserting an angled curette under the posterior arch and identifying the lateral wall of the spinal canal. The screw is medially directed between 5° and 15°. The sagittal angle of screw placement is determined using a lateral radiograph. The screw trajectory should aim between the caudal 20 and 40% of the C1 anterior arch to avoid violation of the CO–C1 and C1–C2 facet joints. This is termed “the safe zone of C1.” The screw is placed, while the vertebral artery is retracted cranially, and the C2 nerve root is retracted caudally to prevent injuries to them. Care should be taken to avoid internal carotid artery injuries, CO–C1 facet joint violation, and vertical splitting of the posterior arch during tapping or screw insertion.

Supplementary material

Video 40.1

(WMV 191263 kb)

370679_1_En_40_MOESM2_ESM.pptx (206.4 mb)
Data 40.2 (PPTX 211381 kb)

Bibliography

  1. 1.
    Yeom JS, Kafle D, Nguyen NQ, et al. Routine insertion of the lateral mass screw via the posterior arch for C1 fixation: feasibility and related complications. Spine J. 2012;12:476–83.CrossRefGoogle Scholar
  2. 2.
    Yeom JS, Buchowski JM, Park KW, et al. Lateral fluoroscopic guide to prevent occipitocervical and atlantoaxial joint violation during C1 lateral mass screw placement. Spine J. 2009;9:574–9.CrossRefGoogle Scholar
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    Estillore RP, Buchowski JM, Minh do V, et al. Risk of internal carotid artery injury during C1 screw placement: analysis of 160 computed tomography angiograms. Spine J. 2011;11:316–23.CrossRefGoogle Scholar
  4. 4.
    Yeom JS, Buchowski JM, Kim H-J, et al. Postoperative occipital neuralgia with and without C2 nerve root transection during atlanto-axial screw fixation: a post-hoc comparative outcome study of prospectively collected data. Spine J. 2013;13:786–95.CrossRefGoogle Scholar
  5. 5.
    Yeom JS, Buchowski JM, Park KW, et al. Undetected vertebral artery groove and foramen violations during C1 lateral mass and C2 pedicle screw placement. Spine. 2008;33:E942–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jin S. Yeom
    • 1
  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSungnamRepublic of Korea

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