Minimally Invasive Approach to Posterior Occiput to C2

The C1-C2 joint is affected by multiple entities that may produce biomechanical instability. Optimal management for atlanto-axial instability has been searched by ways of different surgical techniques with different results, generating discussion between second effects of a particular treatment. Posterior cervical approach dissections can place the axial neck musculature and ligaments at risk of neural denervations or vascular compromise. Either of these entities may result in significant postoperative atrophy, cervical pain, and spine instability. Minimally invasive techniques for the treatment of spinal disorders allow to our patients less morbid procedures with equal or better results compared to conventional surgery. In the following chapter, we review the anatomy of the atlanto-axial joint and propose a minimally invasive trans-muscular C1-C2 fusion technique using C1 lateral-mass screws and C2 pedicular screws. We describe cases with surgical, clinical, and radiographic follow-up.