Inferolateral entry point for c2 pedicle screw fixation in high cervical lesions.
OBJECTIVE
The purpose of this retrospective study was to evaluate the efficacy and safety of atlantoaxial stabilization using a new entry point for C2 pedicle screw fixation.


METHODS
Data were collected from 44 patients undergoing posterior C1 lateral mass screw and C2 screw fixation. The 20 cases were approached by the Harms entry point, 21 by the inferolateral point, and three by pars screw. The new inferolateral entry point of the C2 pedicle was located about 3-5 mm medial to the lateral border of the C2 lateral mass and 5-7 mm superior to the inferior border of the C2-3 facet joint. The screw was inserted at an angle 30° to 45° toward the midline in the transverse plane and 40° to 50° cephalad in the sagittal plane. Patients received followed-up with clinical examinations, radiographs and/or CT scans.


RESULTS
There were 28 males and 16 females. No neurological deterioration or vertebral artery injuries were observed. Five cases showed malpositioned screws (2.84%), with four of the screws showing cortical breaches of the transverse foramen. There were no clinical consequences for these five patients. One screw in the C1 lateral mass had a medial cortical breach. None of the screws were malpositioned in patients treated using the new entry point. There was a significant relationship between two group (p=0.036).


CONCLUSIONS
Posterior C1-2 screw fixation can be performed safely using the new inferolateral entry point for C2 pedicle screw fixation for the treatment of high cervical lesions.
Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea.
Kwang Ho
KH
Lee
Dong Ho
DH
Kang
Chul Hee
CH
Lee
Soo Hyun
SH
Hwang
In Sung
IS
Park
Jin Myung
JM
Jung