Potential intraoperative factors of screw-related complications following posterior transarticular C1–C2 fixation: a systematic review and meta-analysis

  • Ivan LvovEmail author
  • Andrey Grin
  • Aleksandr Talypov
  • Anton Kordonskiy
  • Vladimir Smirnov
  • Iliya Grigoriev
  • Ulugbek Khushnazarov
  • Vladimir Krylov
Review Article



This study aimed to evaluate the impact of several factors, including patients’ intraoperative position, intraoperative visualization technique, fixation method, and type of screws and their parameters, on the frequency of intraoperative screw-associated complications in posterior transarticular C1–C2 fixation.


A systematic review of the PubMed database between January 1986 and March 2018 was performed. The key inclusion criteria comprised detailed descriptions of the surgical technique and post-operative screw-associated complications.


The initial search resulted in 1041 abstracts, and a total of 54 abstracts were included in the present study. The overall number of operated patients was 2306. In this group, 4439 screws were inserted. The rate of screw-associated complications during the different time periods was estimated upon meta-analysis. Statistical analysis of the screw malposition rate, vertebral artery injury rate, screw breakage rate based on patients’ intraoperative position, intraoperative visualization technique, fixation method, and type of implants and their parameters was also performed.


The factors that help reduce the rate of screw-associated complications include the intraoperative application of biplanar fluoroscopy or neuronavigation system, the use of 4 mm or thicker lag screws, and screw insertion through contraincisions using cannulated ported instruments. On the other hand, the potential risk factors of screw-associated complications include inadequate intraoperative head fixation using skeletal traction, uniplanar fluoroscopy-guided screw insertion, screw insertion using the posterior midline approach, and the use of 3.5 mm or thinner full-threaded screws.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Screw-related complications C1–C2 transarticular fixation Vertebral artery injury Screw breakage Screw malposition 



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


No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no confict of interest.

Supplementary material

586_2018_5830_MOESM1_ESM.pptx (39.9 mb)
Supplementary material 1 (PPTX 40822 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sklifosovsky Research Institute of Emergency CareMoscowRussia
  2. 2.A.I. Evdokimov Moscow Medical UniversityMoscowRussia

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