Study design: This is a retrospective review of 150 C2 pedicle screw placements. Candidates had their C2 pedicle morphology assessed through three-dimensional imaging, including preoperative image guidance. After surgery, the patients were serially CT scanned. Follow-up, with fusion assessment, ranged from 1 to 12 years.
Objective: We will show that an open technique combined with lateral C-arm guidance provides rapid placement of C2 pedicle screws.
Summary of background data: C2 pedicle screws can be successful anchors for a variety of cervical problems. Standard intraoperative image guidance, biplane fluoroscopy, or free hand techniques all have their drawbacks.
Methods: After adequate C2 exposure, the C2 pedicle is palpated. The dissector remains stationary to provide coronal orientation while a lateral C-arm radiograph is obtained for sagittal orientation. The drill trajectory is set, the C2 pedicle cannulated, and a cancellous screw placed.
Results: A total of 71 patients had bilateral screws placed and 8 patients had unilateral screws placed. The overall complication rate was 2.7%.
Conclusions: In our series, we have found a consistent way to cannulate the C2 pedicle. C2 fixation serves as an integral part of cervical reconstruction. Preoperative planning, anatomic knowledge, and lateral C-arm orientation create a low morbidity method for C2 screw placement.