Translaminar screws in the atlas

Study Design. This was a retrospective review of a new surgical technique. Objectives. To describe a new method of fixation augmentation in posterior C1-C2 spondylodesis. Summary of Background Data. Posterior atlantoaxial spondylodesis using transarticular screws is often supplemented with sublaminar wires to enhance stability. This technique is not possible if the arch of C1 is deficient. A method of stabilizing the segment and the graft was developed, and the early results were reviewed. Methods. Five patients with a deficient posterior arch of the atlas, who also needed atlantoaxial spondylodesis, were reviewed. In each patient, fixation was augmented with translaminar screws that attached the graft to the arch of C1. Results. In all five patients, solid arthrodesis was achieved, and all had substantial relief of pain. There were no neurologic complications or failures of fixation. Conclusions. The method of fixation of graft to the atlas using translaminar screws is a safe and reasonable alternative to external halo immobilization or more extensive surgery, such as occiput to C2 fusion.