Lateral mass screw placement in the atlas: description of a novel surgical technique, radiographic parameters, and review of the literature

Bilal B Butt; Paul Gagnet; Joshua Piche; Rakesh Patel; Paul Park; Ilyas S Aleem

doi:10.21037/jss-20-566

Lateral mass screw placement in the atlas: description of a novel surgical technique, radiographic parameters, and review of the literature

J Spine Surg. 2021 Sep;7(3):335-343. doi: 10.21037/jss-20-566.

Authors

Bilal B Butt¹, Paul Gagnet¹, Joshua Piche¹, Rakesh Patel¹, Paul Park¹, Ilyas S Aleem¹

Affiliation

¹ Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: Numerous techniques of C1 lateral mass screw placement have been described. We sought to delineate the radiographic angle of safety medially and laterally and describe a novel surgical technique of C1 lateral mass screw placement. We sought to (I) determine the angle of safety medially and laterally of the C1 lateral mass; (II) assess the size available of the lateral mass in the AP and coronal planes; (III) describe novel technique of insertion of a C1 lateral mass screw utilizing navigation and a novel start point.

Methods: We retrospectively reviewed cervical computed tomography (CT) images of normal adults. Radiographic measurements were then obtained using these images including the angle (degrees) of safety medially and lateral of the C1 lateral mass bilaterally, as well as the length and width (mm) of the C1 lateral masses. A novel surgical technique was used by identifying the confluence of the medial aspect of the posterior arch and the lateral mass. This confluence is then marked out as the C1 screw start point. Under navigation guidance, lateral mass screws were placed with 0 degrees of medial-lateral angulation from posterior to anterior.

Results: Forty-five patients with a mean age of 52.6±25.6 years (33% female) were included. The mean medial and lateral angle of safety of the C1 lateral mass bilaterally was 23±3.8 degrees and 32±5 degrees, respectively. Average length and width of the lateral mass was 17.7 and 13.3 mm respectively.

Conclusions: This study describes the radiographic window of safety medially and laterally for safe and reproducible placement of C1 lateral mass screws. Further, a novel technique using a medial start point and navigation guidance with 0 degrees of angulation in the coronal plane is described. Further research is required to assess outcomes of patients utilizing this method as well as biomechanical studies to assess this construct strength compared to others that are frequently used.

Keywords: Atlas; C1; atlantoaxial fusion; cervical fusion.