Minimally Invasive Posterior Trans-muscular C1–C2 Screw Fixation Through an Anatomical Corridor to Preserve Occipitocervical Tension Band: Surgical Anatomy and Clinical Experience

  • Roberto DíazEmail author
  • Miguel E. Berbeo
  • Luis M. Villalobos
  • Manuel F. Vergara
  • Enrique Osorio
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 40)


The C1–C2 joint is affected by multiple entities that may produce biomechanical instability. Optimal management for atlantoaxial instability has been searched by ways of different surgical techniques with different results, generating discussion between second effects of a particular treatment. Lateral dissections can place the axial neck musculature and ligaments at risk of neural denervations or vascular compromise. Either of these entities may result in significant postoperative atrophy, pain, and instability. Minimally invasive techniques for the treatment of spinal disorders allow to our patients less morbid procedures with equal or better results compared to conventional surgery. In the following paper, we review the anatomy of the atlantoaxial joint and propose a minimally invasive trans-muscular C1–C2 fusion technique using C1 lateral-mass screws and C2 pedicular screws. We describe cases with surgical, clinical, and radiographic follow-up.


Atlantoaxial joint C1–C2 instability Minimally invasive Spinal fusion 


  1. 1.
    Claybrooks R, Kayanja M, Milks R, Benzel E (2007) Atlantoaxial fusion: a biomechanical analysis of two C1-C2 fusion techniques. Spine J 7:682–688. Menendez J, Wright N (2007) Techniques of posterior C1-C2 stabilization. Neurosurgery 60 (Suppl 1):103–111Google Scholar
  2. 2.
    Diaz R, Berbeo M, Vergara M, Villalobos L (2009) Minimally invasive posterior C1-C2 screw fixation through an anatomical corridor preserving occipital-cervical tension band. Prospective 21 months clinical and radiological study. Oral presentation, Spine Arthroplasty Society Global symposium on motion Preservation Technology (SAS 9). LondonGoogle Scholar
  3. 3.
    Farey I, Nadkarni S, Smith N (1999) Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion. Clin Orthop Relat Res 359:126–135PubMedCrossRefGoogle Scholar
  4. 4.
    Fessler R, O’Toole J, Eichholz K, Perez-Cruet M (2006) The development of minimally invasive spine surgery. Neurosurg Clin N Am 17:401–409PubMedCrossRefGoogle Scholar
  5. 5.
    Gala VC, O’Toole JE, Voyadzis JM, Fessler RG (2007) Posterior minimally invasive approaches for the cervical spine. Orthop Clin N Am 38(3):339–349; abstract vCrossRefGoogle Scholar
  6. 6.
    Gerszten PC, Welch WC (2006) Spine: minimally invasive techniques. Prog Neurol Surg 19:135–151PubMedCrossRefGoogle Scholar
  7. 7.
    Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129:47–53CrossRefGoogle Scholar
  8. 8.
    Goel A, Desai KI, Muzumdar DP (2002) Atlanto axial fixation using plate and screw method: a report of 160 cases treated patients. Neurosurgery 51:1351–1357PubMedGoogle Scholar
  9. 9.
    Harms J, Melcher R (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 26(22):2467–2471PubMedCrossRefGoogle Scholar
  10. 10.
    Joseffer S, Post N, Cooper P, Fremong-Boadu A (2006) Minimally invasive atlantoaxial fixation with polyaxial screw-rod construct: technical case report. Neurosurgery 58(Suppl 2):ONS-375Google Scholar
  11. 11.
    Menendez J, Wright N (2007) Techniques of posterior C1-C2 stabilization. Neurosurgery 60(Suppl 1):103–111Google Scholar
  12. 12.
    Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) A safe screw trajectory for atlantoaxial transarticular fixation achieved using an aiming device. Spine 30(9):236–242CrossRefGoogle Scholar
  13. 13.
    O’Toole JE, Eichholz KM, Fessler RG (2006) Minimally invasive approaches to vertebral column and spinal cord tumors. Neurosurg Clin N Am 17(4):491–506PubMedCrossRefGoogle Scholar
  14. 14.
    Powers C, Isaacs R (2006) Minimally invasive fusion and fixation techniques. Neurosurg Clin N Am 17:477–489PubMedCrossRefGoogle Scholar
  15. 15.
    Reilly T, Sasso R, Hall P (2003) Atlantoaxial stabilization: clinical comparison of posterior cervical wiring technique with transarticular screw fixation. J Spinal Disord Tech 16(3):248–253PubMedCrossRefGoogle Scholar
  16. 16.
    Shad A, Shariff S, Teddy P (2002) Craniocervical fusion for rheumatoid arthritis: comparison of sublaminar wires and the lateral mass screw craniocervical fusion. Br J Neurosurg 16(5):483–486PubMedCrossRefGoogle Scholar
  17. 17.
    Shchedrenok VV, Ivanenko AV, Sebelev KI, Moguchaia OV (2010) Minimally invasive surgery of degenerative diseases of the spine. Vestn Khir Im I I Grek 169(2):102–104PubMedGoogle Scholar
  18. 18.
    Wang M, Levi A (2006) Minimally invasive lateral mass screw fixation in the cervical spine: initial clinical experience with long-term follow-up. Neurosurgery 58:907–912PubMedCrossRefGoogle Scholar
  19. 19.
    Winder MJ, Thomas KC (2011) Minimally invasive versus open approach for cervical laminoforaminotomy. Le Journal Canadien Des Sciences Neurologiques 38(2):262–267Google Scholar
  20. 20.
    Xiang-Yang M, Qing-Shui Y, Zeng-Hui W, Hong X, Jing-Fa L, Shi-Zhen Z (2005) Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine 30(13):1519–1523CrossRefGoogle Scholar
  21. 21.
    Yoshida M, Neo M, Fujibayashi S, Nakamura T (2006) Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine 31(15):513–517CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Roberto Díaz
    • 1
    Email author
  • Miguel E. Berbeo
    • 1
  • Luis M. Villalobos
    • 2
  • Manuel F. Vergara
    • 2
  • Enrique Osorio
    • 3
  1. 1.Unidad de NeurocirugíaHospital Universitario San Ignacio, Pontificia Universidad JaverianaBogotáColombia
  2. 2.Neurosurgery Resident Unidad de NeurocirugíaHospital Universitario San Ignacio, Pontificia Universidad JaverianaBogotáColombia
  3. 3.Medicine School, Universidad el Bosque, Clínica Reina SofíaBogotáColombia

Personalised recommendations