C1–C2 posterior screw fixation in atlantoaxial fractures revisited: technical update based on 127 cases

  • Niels BuchmannEmail author
  • Claudia Schweizer
  • Jan S. Kirschke
  • Anna Rienmüller
  • Jens Gempt
  • Florian Ringel
  • Bernhard Meyer
  • Yu- Mi Ryang
Original Article



Posterior fusion of traumatic odontoid fractures by C1 lateral mass and C2 isthmic screws (modified Harms–Goel technique) is a viable alternative to transarticular screw fixation due to its universal applicability. This retrospective study reports on a series of 127 patients.

Material and methods

Our clinical database was screened for patients with fractures of the upper cervical spine incorporating a C2 fracture, operated on between 2007 and 2015. Patients were included if fused by internal fixation via C1 lateral mass screws, C2 isthmic screws in freehand technique under lateral fluoroscopy. Screw placement was controlled postoperatively by computed tomography and rated using the Gertzbein & Robbins classification. Surgery-related complications, consecutive treatment, revision surgeries and duration of surgeries were registered.


In total, 127 patients were identified with altogether 572 screws. Correct screw positions of grade A and B according to Gertzbein & Robbins were achieved in a total of 539 (94.2%) screws (grade A: 453 (79.2%); grade B: 86 (15%)), grade C screw malpositions noted in 21 (3.7%), grade D in 10 (1.7%) and grade E in 2 (0.3%) screws. Vertebral artery canal breaches occurred in 29 screws (5.1%), with vertebral artery occlusion in 4 patients. Coiling of injured vertebral artery had to be performed in one patient. None of these patients suffered clinically apparent cerebrovascular complications. Revision surgery was performed in 8 patients (6%).


Posterior fixation of atlantoaxial fractures by C1 lateral mass and C2 isthmic screws with fluoroscopy without navigation is a safe and feasible method but not free of risk of vertebral artery injuries.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Atlantoaxial fracture Posterior screw fixation Accuracy C1–C2 Odontoid fracture 


Compliance with ethical standards

Conflict of interest

All authors state that they have no conflicts of interest.

Supplementary material

586_2019_6244_MOESM1_ESM.pptx (133 kb)
Supplementary file1 (PPTX 132 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Niels Buchmann
    • 1
    • 3
    Email author
  • Claudia Schweizer
    • 1
  • Jan S. Kirschke
    • 2
  • Anna Rienmüller
    • 1
    • 6
  • Jens Gempt
    • 1
  • Florian Ringel
    • 1
    • 5
  • Bernhard Meyer
    • 1
  • Yu- Mi Ryang
    • 1
    • 4
  1. 1.Department of Neurosurgery, Klinikum Rechts Der IsarTechnical University MunichMunichGermany
  2. 2.Department of Neuroradiology, Klinikum Rechts Der IsarTechnical University MunichMunichGermany
  3. 3.Department of Orthopedics and TraumatologyAgatharied Hospital, Norbert-Kerkel-PlatzHaushamGermany
  4. 4.Department of NeurosurgeryHelios Klinikum Berlin-BuchBerlinGermany
  5. 5.Department of Neurosurgery, University MedicineJohannes Gutenberg University MainzMainzGermany
  6. 6.Orthopedic DepartmentUniversity Hospital ViennaViennaAustria

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