Preop
- CT A or MRA – aberrant VA at C2 re: screw placement
Approach
- Posterior midline
Fixation
- O
- Plate with adjustable rod holders
- Unicortical screws (8mm max)
- Major dural vessels just below
- Safe zone – external occipital protuberance
- C1 lateral mass
- Do not dissection above the posterior arch of C1 1cm lateral to midline – VA risk
- C2 screw
- C3 screw
The Spine Book 