Placement of unilateral lag screw through the lateral mass of C-1: description of a novel technique

Abstract

<jats:p>Over the past several decades, many advancements and new techniques have emerged regarding the instrumentation and stabilization of the upper cervical spine. In this article, the authors describe a novel technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening fracture and nonunion of the right C-1 lateral mass approximately 8 weeks after the initial injury, which was sustained when a large tree branch fell onto the patient's posterior head and neck.</jats:p>

Unilateral lag-screw technique for an isolated anterior 1/4 atlas fracture

“…[ 4 7 8 9 10 ] However, due to high infection risk as high as 9-22%[ 11 12 13 14 15 16 ] and technical difficulty, which increases the postoperative complication rate to as high as 75%,[ 17 ] posterior approaches are preferred although there is still a risk of venous plexus and C 2 nerve root injury during exposure of the C 1 lateral mass. [ 18 19 ] The indications for limited posterior lateral mass fixation include fresh isolated atlas posterior 3/4 Jefferson fracture and semi-ring Jefferson fractures[ 9 20 21 22 23 ] associated with C 1 lateral mass, either together with type II transverse ligament injury or that do not heal after external immobilization for 3 months. [ 24 ] Isolated atlas fractures combined with type I ligament injury may have atlantoaxial or atlantooccipital joint instability, and should be treated with C 1 -C 2 or C 0 -C 2 fusion.…”