ABSTRACT

This chapter discusses the surgical technique of arthrodesis using transarticular C1–2 screws. A variety of techniques for posterior C1–C2 fusion have been described, ranging from in situ to wire to those with rigid internal fixation. Until recently, wiring methods were the most popular including the WE Gallie and AL Brooks techniques. Chronic post-traumatic insufficiency may present insidiously and diagnosis may be delayed years after the index injury. Initially, the diagnosis can be missed if a patient is neurologically normal and local pain and spasm limit the amount of displacement on imaging. Careful follow-up and repeat flexion–extension radiographs after acute symptoms have helped to avoid missing the injuries. The close proximity of the vertebral arteries, carotid arteries, brain stem, spinal cord, and cranial nerves demand careful assessment to avoid iatrogenic injury prior to and during placement of transarticular screws. Standard radiographic assessment includes an open-mouth odontoid view and lateral cervical spine radiograph centered at C2.