ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2022
The medial window technique as a salvage method to insert C2 pedicle screw in the case of a high-riding vertebral artery or narrow pedicle: a technical note and case series.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 15 citations in OpenAlex.
- Prevalence of the high-riding vertebral artery depends on how it is defined: a meta-analysis with implications for C2 screw fixation.Anatomical science international · 2026Review
- Evaluation of a novel C2 pedicle screw insertion technique: a retrospective comparative clinical study and finite element analysis.Scientific reports · 2026Article
- C2 direct pedicle screw insertion technique in craniovertebral junction anomaly: safety and efficacy in high-riding vertebral artery cases.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Review
- Article
- Transforaminal "in-out-in" screw technique for posterior C2 fixation in cases with a narrow C2 pedicle: anatomical considerations, technical notes, and preliminary clinical results.Asian spine journal · 2026Article
- Modified classification system of high-riding vertebral artery for the C2 screw placement strategy: a large-scale, cross-sectional study.Scientific reports · 2025Article
- Complications of anterior and posterior surgery for degenerative cervical myelopathy.Journal of clinical orthopaedics and trauma · 2025Article
- C2 pars interarticularis length on the side of high-riding vertebral artery with implications for pars screw insertion.Scientific reports · 2025Article
- Radiological features and internal fixation strategies of atlantoaxial dislocation combined with atlas occipitalization.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- C2 anatomical pedicle screw for C2 fixation under the concept of atlantoaxial joint distraction and fusion with intra-articular cages: technical note.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Enhancing C2 pedicle screw placement in Hangman's fractures: a comparative study of navigation and 3D printed guidance techniques.Frontiers in surgery · 2025Article
- C2 pedicle screw insertion assisted by mobilization of the vertebral artery in cases with high-riding vertebral artery.Heliyon · 2024Article
- Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery.Journal of orthopaedic surgery and research · 2022Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo describe the safety and feasibility of C2 medial window screw (C2MWS) as an alternative salvage method for C2 pedicle screws in cases of high-riding vertebral artery (HRVA) or narrow pedicle.
methodsThe C2MWS technique involves screw insertion by intentionally breaching the medial cortex of the pedicle to avoid vertebral artery injury. Twelve patients who underwent C2 screw insertion via the C2MWS were retrospectively reviewed. C2MWS was indicated in cases of high-riding vertebral artery (HRVA) or narrow pedicle (pedicle width ≤ 4 mm). The width of the canal breach by screw, vertebral artery groove (VAG) breach, solid fusion, neck pain visual analogue scale (VAS) score, and Japanese Orthopedic Association (JOA) score were assessed as outcome measurements.
resultsC2MWS was indicated due to both HRVA and narrow pedicle for 11 screws, narrow pedicle for one screw, and HRVA for two screws. No screw VAG breach or vertebral artery injury was noted postoperatively. The mean width of canal breach was 2.9 ± 1.3 mm. There were no cases demonstrating neurologic deterioration, and 11 patients (91.7%) demonstrated solid fusion at 1-year follow-up. Furthermore, neck pain VAS and JOA scores significantly improved after the surgery.
conclusionsThe C2MWS technique can provide 3-column fixation while reliably avoiding VA injury. C2MWS could be considered as a salvage alternative method when the insertion of C2 pedicle screw is complicated by HRVA or a narrow pedicle, while there is a need to provide firmer fixation strength than that provided by pars or translaminar screws. LEVEL OF EVIDENCE: 4:
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