Paris, France Pedicle screw fixation of the second cervical vertebra was first recommended by Robert Judet, in 1962. The technique is demanding, because of the close proximity of the spinal cord and, above all, of the vertebral artery. In order for the procedure to be performed safely, the surgeon needs to be thoroughly familiar with the anatomical landmarks in this region of the neck, and with certain tips and pitfalls. Under general anaesthesia, the patient is positioned prone, with his or her head fixed on a head rest, which permits the use of skull traction.
Reduction is obtained with hyperlordosis.
The head rest must be capable of being manoeuvred throughout the procedure. Prior to surgery, radiographs are taken. The paraspinal tissues are infiltrated with an adrenaline and saline solution. A posterior midline incision is made in customary fashion, to expose the posterior arches of C1 and C2. The muscles must be detached very cautiously.