Salvage anterior C1-C2 screw fixation and arthrodesis through the lateral approach in a patient with a symptomatic pseudoarthrosis.

On occasions when the posterior approach to the upper cervical spine is not feasible, the options provided by a lateral exposure can be invaluable. A case of a nonunited posterior fusion between C1 and C2, with a free-floating posterior C1 arch due to nonhealing of a previous intraoperative C1 ring fracture, is presented to illustrate this point. This 28-year-old man underwent screw fixation between the first and second cervical vertebrae, supplemented with autogenous iliac crest cancellous bone graft, via the lateral approach of Whitesides. The patient's symptoms subsequently resolved, and radiographic evaluation 3 months after the procedure revealed a solid fusion.