The placement of C1 lateral mass screws is a common procedure in posterior atlantoaxial fixation, but variations in local anatomy, including the C1 lateral mass and vertebral artery, can complicate screw placement, increasing the risk of complications. This case report presents the use of a C1 translaminar screw as a salvage technique following the failure of a C1 lateral mass screw during the treatment of a type II odontoid fracture. A 16-year-old male involved in a motor vehicle accident was scheduled for posterior atlantoaxial fixation with C1 lateral mass screws and C2 pedicle screws. However, intraoperative failure of one C1 lateral mass screw necessitated the insertion of a C1 translaminar screw. Postoperative recovery was without complications, with fracture healing confirmed by computed tomography imaging at 3 months after the operation, showing no signs of implant loosening or delayed union. This case highlights the effectiveness of the C1 translaminar screw as a reliable salvage technique in complex situations where conventional screw placement is compromised. It provides a viable alternative for ensuring stable fixation and achieving favorable outcomes in patients with challenging anatomical variations.
Liu et al. (2026) studied this question.