Peng Xiu, Qing Wang, Gaoju Wang, Song Wang, Guidong Dai, Yongshu Lan

July 2014, Volume 23, Issue 8, pp 1730 - 1736 Original Article Read Full Article 10.1007/s00586-014-3397-5

First Online: 04 June 2014


Congenital C2–3 fusion (C2–3CF) is often involved in patients with atlantoaxial dislocation, and posterior occipitocervical fixation surgery is usually required. Hypoplasia of C2 pedicle is common in such patients, making C2 pedicle screws (PS) instrumentation inapplicable. Because of congenital fusion, C3PS instrumentation would be an ideal alternative for it will not sacrifice an additional motion segment; however, the morphological and clinical feasibility has not been previously reported.


We included 42 C2–3CF patients to this study and evaluated pedicle trajectories of C2 and C3 using a three-dimensional CT. Clinical applications of C3PS instrumentation were evaluated and followed.


Among the 42 patients, 23 (54.8 %) and 8 (19.0 %) had C2 and C3 pedicle trajectory diameters


C3PS instrumentation is morphologically and clinically feasible for a large proportion of patients with C2–3CF and can serve as another reliable alternative for C2PS instrumentation. Preoperative evaluation of pedicle trajectory of C2–3CF with three-dimensional CT is highly valuable in the choice of proper fixation methods.

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