title: Posterior atlantoaxial fixation: A cadaveric and fluoroscopic step-by-step technical guide.
abstract: BACKGROUND
  Atlantoaxial surgical fixation is widely employed treatment strategy for a myriad of pathologies affecting the stability of the atlantoaxial joint. The most common technique used in adults, and in certain cases in children, involves a posterior construct with C1 lateral mass screws, and C2 pars or pedicle screws. This technical note aims to provide a step-by-step guide to this procedure using cadaveric and fluoroscopic images.
  
  
  METHODS
  An embalmed, human, cadaveric, specimen was used for this study. The subject did not have obvious occipital-cervical pathology. Dissections and techniques were performed to mimic actual surgical technique. Photographs were taken during each step, and the critical aspects of each step were highlighted. Fluoroscopic images from a real patient undergoing C1/C2 fixation were also utilized to further highlight the anatomic-radiographic relationships. This study was performed without external or industry funding.
  
  
  RESULTS
  Photographic and radiographic pictures and drawings are presented to illustrate the pertinent anatomy and technical aspects of this technique. The nuances of each step, including complication avoidance strategies are also highlighted.
  
  
  CONCLUSIONS
  Given the widespread utilization of this technique, described step-by-step guide is timely for surgeons and trainees alike.
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Sattarov
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Skoch
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Salman
authors.initials: S
authors.lastname: Abbasifard
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Apar S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Mauricio J
authors.initials: MJ
authors.lastname: Avila
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Walter
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center, 1501 N. Campbell Ave. Tucson, Arizona, 85724, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
keywords: Atlantoaxial fixation; C1 lateral mass; C2 pars; C2 pedicle; goel; harms