Objective and importance: Transarticular screw fixation of the C1-C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient's body habitus.
Clinical presentation: The authors describe a rigid screw technique for the surgical treatment of a woman who was excluded as a candidate for C1-C2 transarticular screw fixation.
Technique: C1-C2 pedicle screw fixation was achieved using a fixed moment arm cantilever beam system. This system provided immediate rigid fixation of the C1-C2 complex in a patient who was not a candidate for transarticular screw fixation.
Conclusion: This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.