title: Modification of Wright's technique for placement of bilateral crossing C2 translaminar screws: technical note.
abstract: BACKGROUND
  Several relatively new screw techniques have been described that rigidly capture the posterior elements of C2. The previously described procedures of axis fixation are technically demanding and place the vertebral artery at some risk. A novel and less technically demanding technique of obtaining C-2 translaminar screws has been recently described. Although the risk of vertebral artery injury has been essentially eliminated, the authors recognize that neurologic injury from breakthrough of the inner cortex of the lamina by the drill or screw is still a possibility.
  
  
  OBJECTIVE
  Describe and illustrate a modified C2 translaminar technique and review the results of patients who have undergone the surgery. The current modification of the C2 translaminar screw technique was designed to reduce the risk of inadvertent screw placement within the spinal canal.
  
  
  METHODS
  A techniques paper combined with a retrospective clinical review of patients undergoing the surgery.
  
  
  METHODS
  Patients undergoing posterior instrumented fusion surgery of the cervical spine, which incorporates C2 posterior elements using the translaminar technique.
  
  
  METHODS
  Radiographic analysis of the fusion construct incorporating the C2 translaminar screws.
  
  
  METHODS
  We have modified the previously described technique of C-2 translaminar screw placement with the addition of "exit" cortical windows to assure bicortical, intralaminar screw placement.
  
  
  RESULTS
  The results of the first six patients with an average follow-up of 12 months demonstrated this method to be safe and effective in fixating the axis.
  
  
  CONCLUSIONS
  We have made a simple modification of Wright's elegant technique with the addition of "exit" windows at the facet-laminar junctions. This gives us the assurance that the C2 screw has not entered the spinal canal by directly visualizing the tip of the screw exiting the outer cortices of the lamina before leaving the operating room.
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, 1095 NW 14th Terrace, D4-6, 2nd floor, Miami, FL 33136, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
authors.forename: Rishi N
authors.initials: RN
authors.lastname: Sheth
authors.forename: Steve
authors.initials: S
authors.lastname: Vanni
authors.forename: Barth A
authors.initials: BA
authors.lastname: Green
authors.forename: Allan D
authors.initials: AD
authors.lastname: Levi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome