Detethering of the C2 Nerve Root and Avoidance of Transection and Injury During C1 Screw Placement: A Cadaveric Feasibility Study.

Abstract

Regional neurovascular structures must be avoided during invasive spine hardware placement. During C1 lateral mass screw placement, the C2 nerve root is put in harm's way. Therefore the current anatomic study was performed to identify techniques that might avoid such neural injury. On 10 cadaveric sides, dissection was carried down to the craniocervical junction. The C2 nerve root was identified, and its distal branches were traced out into the surrounding posterior cervical musculature. Once dissected, the nerve was displaced inferiorly away from the lateral mass of C1. On all sides, the C2 nerve root could be easily detethered from surrounding tissues. On all sides, this allowed lateral mass screw placement without compression of the nerve. On the basis of our cadaveric study, the C2 nerve root can be detethered enough at the level of the posterior lateral mass of C1 to avoid its injury during screw placement into this area.