• Christian Fisahn, Jaspreet Johal, Marc Moisi, Joe Iwanaga, Rod J Oskouian, Jens R Chapman, and R Shane Tubbs.
• 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.
• World Neurosurg. 2017 Jan 1; 97: 221-224.

IntroductionRegional 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.Materials And MethodsOn 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.ResultsOn 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.ConclusionOn 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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