Proximal fixation during a long cervicothoracic realignment and fusion is crucial

Proximal fixation during a long cervicothoracic realignment and fusion is crucial.

Proximal fixation during a long cervicothoracic realignment and fusion is crucial. Understanding the anatomy and different fixation options can help reduce technical complications improving the potential for a successful operation. This is a case of a male in his 70s. He had progressive myeloradiculopathy and pain from his cervical kyphosis. Within the year he transitioned from a cane to a walker to ambulate. We decided on C2-T2 front-back operation for decompression, realignment and fusion. I generally go long on my C2 pars screw (4.0×26-28mm). In this case study of the C2 anatomy on preoperative CT revealed a high riding vertebral artery on the right side. A screw into the vertebral artery could reduce blood flow to the brainstem and cerebellum inducing a stroke. A small change in our plan, we were still able to instrument C2 on the right but we were mindful to stay short of the vertebral foramen based on pre CT measurements. in this case we placed a 20mm screw. We also added a unilateral C2 laminar screw for added proximal fixation and a 3rd rod for additional stability across the CT junction. What are your go to fixation options and bail out strategies in the upper cervical spine? Share pictures!

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