The use of C1 lateral mass fixation in the cervical spine

Purpose of review: To review the recent literature on C1 lateral mass screws and compare the technique with other options. Recent findings: The published literature concerning C1 lateral mass screws is scant, but preliminary clinical results show high success rates and few complications. Morphologically, the lateral mass of the atlas is an excellent anchor point for screw fixation. Biomechanical studies show that the screws have good pullout strength and rod constructs based on C1 lateral mass, and C2 pars interarticularis screws are stable. Summary: C1 lateral mass screws are technically demanding, but they have become popular adjuncts to C1-2 fusions. The screws may prove to be safer than transarticular screws, and they may be inserted in cases in which transarticular screws are contraindicated because of anatomic constraints. C1 lateral mass screw-rod constructs have several advantages over other currently available stabilization techniques. The screws can be inserted before reduction of the atlantoaxial joints, and they can be used to achieve the reduction. The screws do not violate the C1-2 joints, and therefore they can be used for temporary immobilization. The screws do not rely on posterior wiring techniques, so they can be used when the C1 arch is deficient. Careful preoperative planning and meticulous surgical technique are necessary to place the screws safely and replicate the published results.