ArticleFrontiers in surgery2026
Modified high-entry C1 screw placement for bilateral persistent first intersegmental artery in atlantoaxial instability: a case report.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Atlantoaxial instability (AAI) is a recognized cervical manifestation of rheumatoid arthritis (RA) and may require posterior C1-C2 fixation. Conventional C1 lateral mass screw placement can be hazardous when anomalous vertebral artery (VA) anatomy is present, particularly in patients with persistent first intersegmental artery (PFIA). Case description: A 70-year-old woman with long-standing RA presented with a 6-month history of nuchal pain, rotational neck pain, and occipital neuralgia. Plain radiographs demonstrated AAI with an atlantodental interval of 7.5 mm, and magnetic resonance imaging revealed widening of the C1-C2 interspinous space without spinal cord compression. Computed tomography (CT) angiography revealed bilateral PFIA, with both VAs ascending directly into the foramen magnum without traversing the transverse foramen of C1. Because this anatomy directly intersected the conventional C1 lateral mass screw trajectory, a modified high-entry point was selected at the junction of the posterior arch and lateral mass. C1 lateral mass-C2 pedicle screw fixation was performed without intraoperative vascular or neural complication, and postoperative CT confirmed satisfactory implant placement. Early postoperative neck pain and occipital neuralgia improved. Conclusion: In patients with RA-associated AAI and bilateral PFIA, the standard C1 lateral mass trajectory may be unsafe. This case illustrates that a modified high-entry C1 screw placement can be a feasible alternative when guided by careful preoperative vascular imaging and individualized surgical planning.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.