New entry point for C2 screw, in posterior C1-C2 fixation (Goel-Harm's technique) significantly reducing the possibility of vertebral artery injury

Objective: To reduce the chance of vertebral artery injury in posterior C1 lateral mass and C2 pedicle/pars screw-rod fixation (Goel-Harms technique). Method: 49 patients, 30 males and 19 females, 12years - 82 years, underwent posterior C1-C2 fixation from February 2007 till June 2013. A new entry point for the posterior C2 screw, 3mm below the midpoint of the C1-C2 joint which is directed medially and downwards into the C2 body, probably avoids the vertebral artery. As the screw now bypasses the pedicle/pars, the chance of injuring the vertebral artery is probably reduced. Results: No case of intra-operative vertebral artery injury. Conclusion: The new technique of C2 screw fixation allows rigid immobilization of the C1-C2 joint without significant risk of vertebral artery injury.