title: Modification of Wright's technique for C2 translaminar screw fixation: technical note.
abstract: OBJECTIVE
  To describe a modification of Wright's technique for C2 translaminar screw fixation.
  
  
  METHODS
  Bilateral crossing C2 laminar screws have recently become popular as an alternative technique for C2 fixation. This technique is particularly useful in patients with anomalous anatomy, as a salvage technique where other modes of fixation have failed or as a primary procedure. However, reported disadvantages of this technique include breach of the dorsal lamina and spinal canal, early hardware failure and difficulty in bone graft placement due to the position of the polyaxial screw heads. To address some of these issues, a modified technique was used in six patients. In this technique, the upper part of the spinous process of C2 was removed and the entry point of the screw was in the base of this removed spinous process.
  
  
  RESULTS
  The screw position was satisfactory in all patients. There were no intraoperative or early postoperative complications.
  
  
  CONCLUSIONS
  Our modification enables placement of a bone graft on the C2 lamina and is also less likely to cause inadvertent cortical breach. Because of these advantages, it is especially suitable for patients with advanced rheumatoid arthritis with destruction of the lateral masses of C2 or as part of a hybrid construct in patients with a unilateral high-riding vertebral artery. This technique is not suitable for bilateral translaminar screw placement.
authors: The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. rezaulkabir@hotmail.com
authors: S M R
authors: SM
authors: Kabir
authors: A T H
authors: AT
authors: Casey
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013119:Spinal Cord Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D014711:Vertebral Artery / Q000002:abnormalities / Q000601:surgery; D055815:Young Adult