Posterior atlantoaxial fixation: the Magerl screw technique.

Atlantoaxial transarticular fixation is a proven stabilization technique used to augment conventional sublaminar fusion. Along with its superior biomechanical profile comes the inherent risk of neurovascular injury and potential compromised fixation during its application. This article presents a detailed systematic guide to this procedure including preoperative evaluation, positioning, and the more subtle aspects of the surgical technique. A new instrumentation design that has enhanced the ease and accuracy of screw placement with less operative frustration and potential morbidity of previous systems also is presented.