Modification of Wright's technique for placement of bilateral crossing C2 translaminar screws: technical note

BACKGROUND CONTEXT: Several relatively new screw techniques have been described that rigidly capture the posterior elements of C2. The previously described procedures of axis fixation are technically demanding and place the vertebral artery at some risk. A novel and less technically demanding technique of obtaining C-2 translaminar screws has been recently described. Although the risk of vertebral artery injury has been essentially eliminated, the authors recognize that neurologic injury from breakthrough of the inner cortex of the lamina by the drill or screw is still a possibility. PURPOSE: Describe and illustrate a modified C2 translaminar technique and review the results of patients who have undergone the surgery. The current modification of the C2 translaminar screw technique was designed to reduce the risk of inadvertent screw placement within the spinal canal. STUDY DESIGN/SETTING: A techniques paper combined with a retrospective clinical review of patients undergoing the surgery. PATIENT SAMPLE: Patients undergoing posterior instrumented fusion surgery of the cervical spine, which incorporates C2 posterior elements using the translaminar technique. OUTCOME MEASURES: Radiographic analysis of the fusion construct incorporating the C2 translaminar screws. METHODS: We have modified the previously described technique of C-2 translaminar screw placement with the addition of "exit" cortical windows to assure bicortical, intralaminar screw placement. RESULTS: The results of the first six patients with an average follow-up of 12 months demonstrated this method to be safe and effective in fixating the axis. CONCLUSIONS: We have made a simple modification of Wright's elegant technique with the addition of "exit" windows at the facet-laminar junctions. This gives us the assurance that the C2 screw has not entered the spinal canal by directly visualizing the tip of the screw exiting the outer cortices of the lamina before leaving the operating room. (C) 2008 Elsevier Inc. All rights reserved.