• Sai Kiran Narayanam Anantha NA Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India. Electronic address: saikiran, Laxminadh Sivaraju, Kanneganti Vidyasagar, Sarita Aryan, Vivek Raj, Niranjana Rajagopal, Dilip Mohan, Sumit Thakar, Arun Sadashiva Rao, and Alangar S Hegde.
• Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India. Electronic address: saikiransssihms@gmail.com.
• World Neurosurg. 2018 Oct 1; 118: e304-e315.

ObjectiveTo evaluate the safety and accuracy of anatomic- and lateral fluoroscopic-guided placement of C2 pars/pedicle, C1 lateral mass screws, and freehand placement of C2 laminar screws.MethodsAll the patients who underwent posterior cervical/occipitocervical fixation that involved the placement of C1/C2 screws during a 5-year period (2011-2015) at our institute were included in this study.ResultsC1/C2 screws were placed in a total of 94 patients during this period. A total of 97 C1 lateral mass, 49 C2 pars, 24 C2 pedicle, and 82 C2 laminar screws were placed in these patients. C1 lateral mass screws and C2 pars/pedicle screws were placed under anatomic and lateral fluoroscopic guidance. C2 laminar screws were placed by a freehand technique. The mean length (range) of various C2 screws was 16.4 ± 2.6 mm (12-22 mm) for pars screws, 18.8 ± 2.7 mm (14-24 mm) for pedicle screws, and 25.6 ± 3.4 mm (18-32 mm) for laminar screws. Postoperative CT imaging done in all patients before discharge revealed malposition of 2 laminar screws with breach of the inner cortex. The position of the remaining C1/C2 screws was perfect. The superior and medial angulation of the pars screws and superior angulation of the pedicle screws as measured in postoperative CT images were found to significantly deviate from the angles described in the literature. There was no mortality, vertebral artery injury, or neurologic injury related to C1/C2 screw placement in this series.ConclusionsAnatomic and lateral fluoroscopic-guided placement of C2 pars/pedicle screws and C1 lateral mass screws and freehand placement of C2 laminar screws is extremely safe.Copyright © 2018 Elsevier Inc. All rights reserved.

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