The Feasibility Study of C1 Posterior Arch Crossing Screw Fixation in Adult Thai Population: A Computed Tomographic Morphometric Analysis Study

Objective: Atlantoaxial instability can be caused by various etiologies and surgical fixation is often required. Various methods have been described for atlantoaxial fixation. Screw fixation is associated with an increased risk of vertebral artery injury especially in patients with an anomalous vertebral artery location or abnormal bony anomalies. A new C1 posterior arch crossing screw fixation technique was proposed to reduce the risk of vertebral artery injury. The present study aimed to assess morphometric CT analysis of atlas for C1 posterior arch crossing screw fixation in Thai people. Materials and Methods: The present research was an observational study that reviewed 150 computed tomography (CT) scans of the patients who had neck trauma or any other complaint requiring craniocervical investigations. Atlantoaxial articulation deformities due to trauma, infections, neoplasm, congenital anomaly, inflammatory disease, incomplete CT scan analysis, and history of surgical intervention of the cervical spine were excluded. All the images were measured for the height of the posterior tubercle, the width of the posterior arch was measured bilaterally in three parts on the axial plane, part 1: medial of the VA groove, where the arch transforms into the VA groove, part 2: the middle part between the posterior tubercle and medial of the VA, and part 3: posterior tubercle, length of the screw, and the screw projection angle was calculated. Results: Out of the 139 CT scans analyzed, the mean measurement of posterior arch height was 7.45±1.03 mm, wherein 73.3% exceed 7 mm. The mean width of the left posterior arch in part 1, 2, and 3 was 4.50±0.70 mm, 4.90±0.70 mm, and 5.70±0.80 mm, respectively, and the width of the right posterior arch in part 1, 2, and 3 was 4.50±0.70 mm, 4.80±0.70 mm, and 5.60±0.80 mm, respectively. The mean crossing screw length of the Left and Right was 17.02±3.04 mm and 17.37±2.75 mm, respectively. The mean angle of screw of the Left and Right was 24.62±3.38 degrees and 24.78±3.57 degrees, respectively. There were no significant differences in these variables between gender or sides (p>0.05) except the mean angle of the screw between gender (p<0.05). Conclusion: C1 posterior arch screw fixation is feasible in the adult Thai population. Preoperative thin-cut CT is essential for planning successful posterior arch crossing screws placement. Keywords: C1 posterior arch, Computed tomography, Crossing screw fixation