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

Abstract

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 June2013. 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.