• Takeshi Hara, Hirokazu Iwamuro, Yukoh Ohara, Hidenori Matsuoka, Naoko Kikuchi, Takaoki Kimura, Hajime Arai, and Junichi Mizuno.
• Department of Neurosurgery, Juntendo University, Tokyo, Japan. Electronic address: thara79nouge@gmail.com.
• World Neurosurg. 2020 Feb 1; 134: 378-382.

BackgroundAtlantoaxial transarticular screw fixation (TASF) is a procedure that involves inserting screws vertically into the articular processes of C1 and C2. However, this procedure is associated with a risk of injury to surrounding structures including the vertebral artery, carotid artery, pharynx, and spinal cord by misinserting K-wires or screws. This study was performed to evaluate the risk of TASF using 3-dimensional navigation-guided drilling and screw insertion tract creation.MethodsThree patients underwent the surgical procedure using a navigation system guided by intraoperative computed tomography. The insertion tract of the screw was created using the navigation system to avoid penetration of the C1 anterior arch or damage to the vertebral artery. A blunt-tipped guide wire was used, which was safe to advance to the cortex of the anterior arch of C1.ResultsThere were no complications or instrument failures in any of the surgeries. In each case, the total radiation dose delivered was 5.31-7.02 mGy, and total radiation exposure time was 55.6-106.8 seconds. Bone fusion was achieved in all cases.ConclusionsTASF using a navigation system for drilling is useful for accurate placement of K-wire and preventing damage of the vital structures, lowering the risk of the procedure.Copyright © 2019 Elsevier Inc. All rights reserved.

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