European Spine Journal

, Volume 27, Supplement 3, pp 347–352 | Cite as

Anterior transarticular C1–C2 fixation with contralateral screw insertion: a report of two cases and technical note

  • Ivan Lvov
  • Andrey Grin
  • Aleksandr Kaykov
  • Vladimir Smirnov
  • Vladimir Krylov
Case Report



Anterior transarticular fixation of the C1–C2 vertebrae is a well-known technique that involves screw insertion through the body of the C2 vertebra into the lateral masses of the atlas through an anterior transcervical approach. Meanwhile, contralateral screw insertion has been previously described only in anatomical studies.


We describe two case reports of the clinical application of this new technique.


In Case 1, the patient was diagnosed with an unstable C1 fracture. The clinical features of the case did not allow for any type of posterior atlantoaxial fusion, Halo immobilization, or routine anterior fixation using the Reindl and Koller techniques. The possible manner of screw insertion into the anterior third of the right lateral mass was via a contralateral trajectory, which was performed in this case. Case 2 involved a patient with neglected posteriorly dislocated dens fracture who could not lie in the prone position due to concomitant cardiac pathology. Reduction of atlantoaxial dislocation was insufficient, even after scar tissue resection at the fracture, while transdental fusion was not possible. Considering the success of the previous case, atlantoaxial fixation was performed through the small approach, using the Reindl technique and contralateral screw insertion.


These two cases demonstrate the potential of anterior transarticular fixation of C1–C2 vertebrae in cases where posterior atlantoaxial fusion is not achievable. This type of fixation can be performed through a single approach if one screw is inserted using the Reindl technique and another is inserted via a contralateral trajectory.


Anterior transarticular C1–C2 fixation Atlantoaxial instability Contralateral screw insertion Jefferson fracture Neglected dens fracture 



We would like to thank Editage ( for English language editing.

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.


  1. 1.
    Lu J, Ebraheim NA, Yang H, Heck BE, Yeasting RA (1998) Anatomic considerations of anterior transarticular screw fixation for atlantoaxial instability. Spine 23:1229–1235CrossRefPubMedGoogle Scholar
  2. 2.
    Reindl R, Sen M, Aebi M (2003) Anterior instrumentation for traumatic C1–C2 instability. Spine 28:E329–E3233CrossRefPubMedGoogle Scholar
  3. 3.
    Sen MK, Steffen T, Beckman L, Tsantrizos A, Reindl R, Aebi M (2005) Atlantoaxial fusion using anterior transarticular screw fixation of C1–C2: technical innovation and biomechanical study. Eur Spine J 14:512–518CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Koller H, Kammermeier V, Ulbricht D, Assuncao A, Karolus S, van den Berg B et al (2006) Anterior retropharyngeal fixation C1–2 for stabilization of atlantoaxial instabilities: study of feasibility, technical description and preliminary results. Eur Spine J 15:1326–1338CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lapsiwala SB, Anderson PA, Oza A, Resnick DK (2006) Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior trans- articular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery 58:516–521CrossRefPubMedGoogle Scholar
  6. 6.
    Ji W, Zheng M, Tong J, Huang Z, Chen J, Qu D et al (2015) Feasibility and trajectory study of anterior transarticular crossing screw placement for atlantoaxial joint instability: a cadaveric study and description of a novel technique. Eur Spine J 24:2954–2960CrossRefPubMedGoogle Scholar
  7. 7.
    Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK (1997) Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine 22:1843–1852CrossRefPubMedGoogle Scholar
  8. 8.
    Jacobson ME, Khan SN, An HS (2012) C1–C2 posterior fixation: indications, technique, and results. Orthop Clin N Am 43:11–18CrossRefGoogle Scholar
  9. 9.
    Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Frempong-Boadu A et al (2014) Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs: meta-analysis and review of literature. J Spinal Disord Tech 27:11–28CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of NeurosurgerySklifosovsky Research Institute of Emergency CareMoscowRussia
  2. 2.Evdokimov Moscow Medical UniversityMoscowRussia
  3. 3.Sklifosovsky Research Institute of Emergency CareMoscowRussia

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