Translaminar screw of C1 for the reinforcement of subaxial cervical spine reconstruction

Abstract

Translaminar screws in the cervical spine have been mostly employed at C2 level when conventional trajectories are challenging. However, reports in the literature of translaminar screw of C1 are remarkably anecdotal. We aimed to report a case using C1 translaminar in addition to C1 lateral mass screws for the reinforcement of subaxial cervical spine reconstruction. We present a 22-year-old female patient, who developed persistent cervical pain, and computed tomography scan demonstrated lytic lesions of the vertebral bodies and lateral masses from C3 to C6. Magnetic resonance imaging showed spinal cord compression without myelopathy. Surgical biopsy was inconclusive, and an oncological vertebral instability led to surgical stabilization. Laminectomy and bilateral facetectomy of levels involved was achieved, instrumentation from C1 to T3 and reconstruction with posterolateral fibula bilaterally, and without occipital fixation. A third satellite rod was placed using C1-2–7 translaminar screws. Translaminar screw of C1 is a feasible alternative for increasing the strength of the construct.