Abstract
Starting a C1 screw at the posterior arch has advantages over starting it directly in the lateral mass, including decreased C2 root irritation, and bleeding from the paravertebral venous plexus. However, if the posterior arch is too small, it may not be feasible and might lead to vertebral artery injury, particularly if there is a ponticulus posticus. We are not aware of a report analyzing the feasibility and complications of the routine use of such a screw in a live surgical setting.
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