Skip to main content
SpringerLink
Log in

Atlas (C1) lateral mass screw placement using the intersection between lateral mass and inferomedial edge of the posterior arch: a cadaveric study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To compare the Atlas (C1) lateral mass screw placement between screw trajectories of 0° and 15° medial angulation while using the intersection between lateral mass and inferomedial edge of the posterior arch.

Methods

Forty-eight Atlas lateral masses were prepared and divided into 2 groups: Group 1; screws inserted at 3 mm lateral to the reference point with screw trajectory of 0° angulation(N = 24) and Group 2; those inserted with screw trajectory of 15° medial angulation(N = 24). We evaluated the atlas anatomy, screw purchase and the presence of any breaches using CT scan.

Results

The radiographic parameters for Groups 1 and 2 were found statistically different (p-value < 0.05): bilateral intraosseous screw lengths (17.92 ± 1.47 mm. vs. 20.71 ± 2.4 mm.), bilateral screw length (29.92 ± 1.72 mm. vs. 33.13 ± 1.78 mm.), left screw medial angulation (x°) (0.67° ± 0.78° vs.14.17° ± 3.51°), right screw medial angulation (y°) (0.83° ± 1.03° vs.14.25° ± 2.53°) and bilateral screw medial angulation (0.75° ± 0.9° vs. 14.21° ± 2.99°). Twenty-two screws (91.67%) using the 0° medial angulation and nineteen screws (79.17%) using the 15° medial angulation had no cortical violations (Grade 0). However, two screws (8.33%) with 0° medial angulation and five screws (20.83%) with 15° medial angulation had breach less than 2 mm (Grade 1). There were no screws with breach between 2 and 4 mm (Grade 2) or greater than 4 mm. (Grade 3).

Conclusion

A starting point of 3-mm lateral to the intersection between lateral mass and inferomedial edge of the Atlas posterior arch can be safely and effectively used to insert C1 lateral mass using both 0° and 15° medial angulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Simsek S, Yigitkanli K, Seckin H et al (2009) Freehand C1 lateral mass screw fixation technique: our experience. Surg Neurol 72:676–681. https://doi.org/10.1016/j.surneu.2009.06.015

    Article  Google Scholar 

  2. Butt BB, Gagnet P, Piche J et al (2021) Lateral mass screw placement in the atlas: description of a novel surgical technique, radiographic parameters, and review of the literature. J Spine Surg 7:335–343. https://doi.org/10.21037/jss-20-566

    Article  Google Scholar 

  3. Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129:47–53. https://doi.org/10.1007/BF01400872

    Article  CAS  Google Scholar 

  4. Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471. https://doi.org/10.1097/00007632-200111150-00014

    Article  CAS  Google Scholar 

  5. Du JY, Aichmair A, Kueper J et al (2015) Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine 22:151–161. https://doi.org/10.3171/2014.10.SPINE13805

    Article  Google Scholar 

  6. Cadena G, Duong HT, Liu JJ, Kim KD (2018) Atlantoaxial fixation using C1 posterior arch screws: feasibility study, morphometric data, and biomechanical analysis. J Neurosurg Spine 30:314–322. https://doi.org/10.3171/2018.8.SPINE18160

    Article  Google Scholar 

  7. Hu Y, Dong W-X, Spiker WR et al (2017) Optimal entry point and trajectory for anterior C1 lateral mass screw. Clin Spine Surg 30:E662–E668. https://doi.org/10.1097/BSD.0000000000000280

    Article  Google Scholar 

  8. Bunmaprasert T, Puangkaew W, Sugandhavesa N et al (2021) The intersection between lateral mass and inferomedial edge of the C1 posterior arch: a reference point for C1 lateral mass screw insertion. Neurospine 18:328–335. https://doi.org/10.14245/ns.2040814.407

    Article  Google Scholar 

  9. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–14. https://doi.org/10.1097/00007632-199001000-00004

    Article  CAS  Google Scholar 

  10. Jacobson ME, Khan SN, An HS (2012) C1–C2 posterior fixation: indications, technique, and results. Orthop Clin North Am 43:11–18. https://doi.org/10.1016/j.ocl.2011.09.004

    Article  Google Scholar 

  11. Bunmaprasert T, Trirattanapikul V, Sugandhavesa N et al (2021) Reducible nonunited type II odontoid fracture with atlantoaxial instability: outcomes of two different fixation techniques. Int J Environ Res Public Health 18:7990. https://doi.org/10.3390/ijerph18157990

    Article  Google Scholar 

  12. Currier BL, Yaszemski MJ (2004) The use of C1 lateral mass fixation in the cervical spine. Curr Opin Orthop 15:184–191

    Article  Google Scholar 

  13. Simsek S, Yigitkanli K, Seçkin H et al (2009) Ideal screw entry point and projection angles for posterior lateral mass fixation of the atlas: an anatomical study. Eur Spine J 18:1321–1325. https://doi.org/10.1007/s00586-009-1105-7

    Article  Google Scholar 

  14. Huang D-G, Hao D-J, He B-R et al (2015) Posterior atlantoaxial fixation: a review of all techniques. Spine J 15:2271–2281. https://doi.org/10.1016/j.spinee.2015.07.008

    Article  Google Scholar 

  15. Currier BL, Maus TP, Eck JC et al (2008) Relationship of the internal carotid artery to the anterior aspect of the C1 vertebra: implications for C1–C2 transarticular and C1 lateral mass fixation. Spine 33:635–639. https://doi.org/10.1097/BRS.0b013e318166e083

    Article  Google Scholar 

  16. Hong JT, Lee SW, Son BC et al (2006) Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass. Case report J Neurosurg Spine 5:83–85. https://doi.org/10.3171/spi.2006.5.1.83

    Article  Google Scholar 

  17. Estillore RP, Buchowski JM, Minh DV et al (2011) Risk of internal carotid artery injury during C1 screw placement: analysis of 160 computed tomography angiograms. Spine J 11:316–323. https://doi.org/10.1016/j.spine.2011.03.009

    Article  Google Scholar 

  18. Sai Kiran NA, Sivaraju L, Vidyasagar K et al (2018) Safety and accuracy of anatomic and lateral fluoroscopic-guided placement of C2 pars/pedicle screws and C1 lateral mass screws, and freehand placement of C2 laminar screws. World Neurosurg 118:e304–e315. https://doi.org/10.1016/j.wneu.2018.06.184

    Article  Google Scholar 

  19. Pan J, Li L, Qian L et al (2010) C1 lateral mass screw insertion with protection of C1–C2 venous sinus: technical note and review of the literature. Spine 35:E1133-1136. https://doi.org/10.1097/BRS.0b013e3181e215ff

    Article  Google Scholar 

Download references

Acknowledgements

All authors thank Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, for their support.

Funding

Not applicable. No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand

    Wongthawat Liawrungrueang

  2. Department of Neurological Surgery, Weill-Cornell Medicine and Department of Orthopedic Surgery, The Och Spine Hospital at New York Presbyterian Hospital, Columbia University, New York, NY, USA

    K. Daniel Riew

  3. Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Nantawit Sugandhavesa & Torphong Bunmaprasert

Authors
  1. Wongthawat Liawrungrueang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Daniel Riew
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nantawit Sugandhavesa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Torphong Bunmaprasert
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, analysis and editing manuscript were performed by WL, KDR, NS and TB. The first draft of the manuscript was written by WL, KDR and TB. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Torphong Bunmaprasert.

Ethics declarations

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Consent for publication

Human cadaveric was provided informed consent regarding publishing data and photographs.

Ethical approval.

This study was conducted in accordance with the Declaration of Helsinki and with approval from the Ethics Committee and Institutional Review Board of Faculty of Medicine, Chiang Mai University (Institutional Review Board (IRB) approval, IRB Number: ORT-2564-08306). Informed consent was obtained from the individuals who had donated their bodies or their next of kin. Informed written consent was provided by every participant.

Consent to participate

Informed consent was obtained from all individual participants and/or parents included in the study. Informed Consent Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liawrungrueang, W., Riew, K.D., Sugandhavesa, N. et al. Atlas (C1) lateral mass screw placement using the intersection between lateral mass and inferomedial edge of the posterior arch: a cadaveric study. Eur Spine J 31, 3443–3451 (2022). https://doi.org/10.1007/s00586-022-07385-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07385-7

Keywords

Search

Navigation