The majority of specimens can safely accept placement of a laminar screw. This study establishes anatomic guidelines to allow for accurate screw selection and insertion. Preoperative planning is essential for safe screw placement via this technique.
Our results suggest that although only a small percentage of patients can accept a screw that is directly inserted via the posterior-lateral arch into the lateral mass, the notching technique is possible in the vast majority of patients. To our knowledge, this is the largest study to examine the possibility of using the posterior-lateral arch as the starting point for these screws. Our results suggest that alternative starting points for these screws are possible in a large percentage of the cases.
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