title: Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass.
abstract: METHODS
  This study is a result of manual and radiologic measurements of 50 isolated anatomic specimens of C1 and five patients of atlantoaxial instability treated by screw fixation via posterior arch and lateral mass.
  
  
  OBJECTIVE
  To investigate the feasibility of screw placement via posterior arch and lateral mass in atlas.
  
  
  BACKGROUND
  Several types of posterior approaches have been adopted for stabilization and fusion of atlantoaxial complex. Before this study, Gallie in 1939 gave a report on a posterior wiring technique that depended on a structural bone graft. Since then, double-looped wiring with two bone grafts and Halifax clamp technique had been introduced. A transarticular screw fixation technique was introduced by Magerl and Seeman in 1987, and a C1 lateral mass screw fixation technique was described by Harms in 2001. However, the feasibility of screw fixation in atlas via posterior arch and lateral mass has not been addressed until now.
  
  
  METHODS
  Fifty dry samples of atlas were measured manually and radiologically with vernier calipers, protractors, and CT. The parameters of posterior arch, lateral mass, vertebral artery groove, axis length of screw path via posterior arch and lateral mass, the entry point, and screw direction were measured. Five patients of atlantoaxial instability were treated with this technique and the radiographs and CT scans were evaluated after surgery.
  
  
  RESULTS
  The longest trajectory distance of the screw path was about 30 mm. The outer thickness at the thinnest part of groove was 4.58 mm, and it was found to be <4 mm in four cases (8%). The entry point is 18-20 mm lateral to the midline and 2 mm superior to the inferior border of posterior arch. The direction of screw placement is perpendicular to the coronal plane and about 5 degrees cephalad to the transverse plane. Ten screws via posterior arch and lateral mass were placed properly, without incidence of nerve or blood vessel injury in clinical practice.
  
  
  CONCLUSIONS
  Atlas is capable for screw fixation via its posterior arch and lateral mass.
authors.affiliation: Department of Orthopedics Surgery, China-Japan Friendship Hospital, Ministry of Health, Beijing, People's Republic of China. zrtanms@sina.com
authors.forename: Mingsheng
authors.initials: M
authors.lastname: Tan
authors.forename: Huimin
authors.initials: H
authors.lastname: Wang
authors.forename: Yunting
authors.initials: Y
authors.lastname: Wang
authors.forename: Guangbo
authors.initials: G
authors.lastname: Zhang
authors.forename: Ping
authors.initials: P
authors.lastname: Yi
authors.forename: Zirong
authors.initials: Z
authors.lastname: Li
authors.forename: Hongyu
authors.initials: H
authors.lastname: Wei
authors.forename: Feng
authors.initials: F
authors.lastname: Yang
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery; D001863:Bone Screws / Q000592:standards / Q000706:statistics & numerical data*; D001270:Cervical Atlas / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome