Publication: Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection
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Date
2023-10-01
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Abstract
Objective: In neurosurgery, posterior approaches intended at the craniovertebral junction are frequently used. The most popular procedures
for treating upper cervical instability are C1 lateral mass, C2 pedicle, and C1-C2 transarticular screw stabilization. Due to their proximity to
neural structures and the presence of the high-riding vertebral artery (VA), these techniques are complicated. The risk of VA damage can be
decreased by mobilizing the VA. Using cadaveric specimens in this study was aimed to demonstrate C2 pedicle and C1-C2 transarticular screw
placement with VA mobilization and a novel C2 inferior corpus screw placement technique.
Methods: In this study, twelve adult cadaveric specimens and two adult dry cadaveric C2 bones were used with the permission and decision of
the University Research Ethics Committee. Colored silicone was injected into the arteries and veins of these twelve cadaveric specimens. Then,
muscle dissection was performed stepwise, and the C2 vertebrae of the cadavers were revealed with a surgical microscope. Each specimen and
entire stages of the dissections were recorded photographically. After cadaver dissections, screw placement was performed with three different
techniques. Finally, radiological imaging was done with fluoroscopy.
Results: After dissection, the lateral mass of the C2 vertebra was
observed, and lateral to it, the transverse process and foramen were
detected with the help of a hook. Next, the posterior wall of the VA
groove was removed using a 1 mm thin plate Kerrison rongeur until
the VA loop could partially be observed the VA. This enables us to
find the top of the loop of the VA and mobilize it inferiorly using a
dissector. Following this step, the C1-2 transarticular, C2 pedicle,
and the novel C2 inferior corpus screw placement can be performed
safely by directly visualizing the artery.
Conclusions: Due to the nearby neurologic and vascular
structures, placing the C2 pedicle and C1-2 transarticular screw is a
challenging procedure, especially in high-riding VA cases. However,
it is possible to place the C2 pedicle, C1-2 transarticular, and novel
C2 inferior corpus screw after the mobilization of the VA. This study
aimed to show all of them together on a cadaver for the first time,
to understand the anatomy of the C2 vertebra, and to use screw
placement techniques to minimize the risk of complications.
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Keywords
Axis anatomy, C2 anatomy, C2 screw placement, high-riding vertebral artery, mobilization of vertebral artery
Citation
HARMAN F., OĞLİN V., Yılmaz M. Ö., Orhun Ö., BARAN O., Böyükyılmaz Ş., GEZERCAN Y., DALBAYRAK S., DAĞÇINAR A., "Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection", JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE, cilt.14, 2023