title: Detethering of the C2 Nerve Root and Avoidance of Transection and Injury During C1 Screw Placement: A Cadaveric Feasibility Study.
abstract: BACKGROUND
  Regional neurovascular structures must be avoided during invasive spine hardware placement. During C1 lateral mass screw placement, the C2 nerve root is put in harm's way. Therefore the current anatomic study was performed to identify techniques that might avoid such neural injury.
  
  
  METHODS
  On 10 cadaveric sides, dissection was carried down to the craniocervical junction. The C2 nerve root was identified, and its distal branches were traced out into the surrounding posterior cervical musculature. Once dissected, the nerve was displaced inferiorly away from the lateral mass of C1.
  
  
  RESULTS
  On all sides, the C2 nerve root could be easily detethered from surrounding tissues. On all sides, this allowed lateral mass screw placement without compression of the nerve.
  
  
  CONCLUSIONS
  On the basis of our cadaveric study, the C2 nerve root can be detethered enough at the level of the posterior lateral mass of C1 to avoid its injury during screw placement into this area.
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany. Electronic address: christian.fisahn@swedish.org.
authors.forename: Christian
authors.initials: C
authors.lastname: Fisahn
authors.affiliation: Seattle Science Foundation, Seattle, Washington, USA.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Johal
authors.affiliation: Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Moisi
authors.affiliation: Seattle Science Foundation, Seattle, Washington, USA.
authors.forename: Joe
authors.initials: J
authors.lastname: Iwanaga
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskouian
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Seattle Science Foundation, Seattle, Washington, USA.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
mesh_terms: D001863:Bone Screws; D002102:Cadaver; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000473:pathology / Q000601:surgery; D008297:Male; D013126:Spinal Nerve Roots / Q000473:pathology / Q000601:surgery*
keywords: C1 lateral mass screw; C2 nerve root; Detethering; Spine