C2/3 Transfacetal fixation: An underutilized technique of C2 fixation in the management of atlantoaxial dislocation - A technical note with review of literature

Abstract

Background: Atlantoaxial Dislocation (AAD) is a complex disorder of craniovertebral junction (CVJ). Many techniques are available to treat AAD but there are some specific conditions where some techniques have advantage over the other.

Technical advantage: C2-3 transfacetal screw with standard C1 lateral mass fixation provides a stronger construct because of four cortices incorporation and divergent course of screws and is biomechanically comparable to other forms of C2 fixation techniques. It is a technically less demanding and time-consuming. It is also a good alternative in cases having significant osteopenia.

Conclusion: C2-3 transfacetal screw with standard C1 lateral mass fixation is an effective alternative to routine C1 lateral mass and C2 pedicle/pars screw fixation in cases of atlantoaxial dislocation complicated with high riding or posteriorly placed vertebral artery and thin pedicle of C2 vertebra.

Keywords: Atlantoaxial dislocation; C2 pedicle; C2/3 transfacetal screws; high riding vertebral artery.