Different techniques of atlantoaxial posterior screw fixation with a special attention to high riding vertebral artery
Nasef, N., Sherin, A., Abdelbary, M. (2025). Different techniques of atlantoaxial posterior screw fixation with a special attention to high riding vertebral artery. EKB Journal Management System, 20(1), 77-86. doi: 10.21608/pajn.2025.330847.1157
Nabil Amin Nasef; Ahmed Sherin; Mohamed Elsayed Abdelbary. "Different techniques of atlantoaxial posterior screw fixation with a special attention to high riding vertebral artery". EKB Journal Management System, 20, 1, 2025, 77-86. doi: 10.21608/pajn.2025.330847.1157
Nasef, N., Sherin, A., Abdelbary, M. (2025). 'Different techniques of atlantoaxial posterior screw fixation with a special attention to high riding vertebral artery', EKB Journal Management System, 20(1), pp. 77-86. doi: 10.21608/pajn.2025.330847.1157
Nasef, N., Sherin, A., Abdelbary, M. Different techniques of atlantoaxial posterior screw fixation with a special attention to high riding vertebral artery. EKB Journal Management System, 2025; 20(1): 77-86. doi: 10.21608/pajn.2025.330847.1157

Different techniques of atlantoaxial posterior screw fixation with a special attention to high riding vertebral artery

Pan Arab Journal of Neurosurgery
Article 11, Volume 20, Issue 1, June 2025, Page 77-86  XML PDF (1.14 MB)
Document Type: Original Articles
DOI: 10.21608/pajn.2025.330847.1157
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Authors
Nabil Amin Nasef1; Ahmed Sherin email orcid 2; Mohamed Elsayed Abdelbaryorcid 3
1Department of Neurosurgery. Kafr El-Sheikh University.
2Lecturer of Neurosurgery Neurosurgery Department Alexandria Universtity
3Neurosurgery depatement, Alexandria University, faculty of medicine
Abstract
Background: Posterior atlantoaxial fixation (AAF) is a standard surgical procedure for atlantoaxial joint instability (AAI). C1 lateral mass-C2 pedicle screw fixation is the most common adopted technique with high fusion rate, High riding vertebral artery (HRVA) represents a challenge in atlantoaxial fixation..
Aim: to evaluate AAF in patients with AAI, assessing treatment outcomes, and complication,s especially with HRVA.
Materials and Methods: Retrospective study of 174 patients with AAI, aged 11-68 years old underwent posterior AAF between March 2011 and July 2023 with a minimal follow up period of 1 year. Patients’ demographics, clinical presentation, HRVA presence, operative data, and treatment outcomes will be tabulated and analyzed.

Results: 58 patients underwent AAF. HRVA was noted in 10 patients (17.2%). 4 patients had bilateral HRVA, and 6 patients had unilateral HRVA. In cases with bilateral HRVA, 3 cases used bilateral C2 laminar screws, and 1 case used bilateral C2 pars screws. In cases with unilateral HRVA, 3 patients had unilateral pars screws, 2 patients had unilateral laminar screws, and 1 patient had C2 pedicle clamp. Postoperatively, there were statistically significant clinical and functional improvements. Fusion was achieved in 98.3%. Complications were venous bleeding in 6 patients, infection in 1 case, irritation of the C2 root in 1patient. Vertebral artery injury occurred in 1 case.
Conclusions: Careful preoperative radiological studies are crucial for identifying HRVA. Different techniques of atlantoaxial posterior fixation are used to reduce VA injury. The selection of fixation techniques with HRVA must be individualized based on the patient's anatomical challenges.
Keywords
Posterior atlantoaxial screw fixation; High riding vertebral artery; C2 pedicle screw; atlantoaxial instability
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