{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:16:22Z","timestamp":1788315382989,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007452","name":"Wu Jieping Medical Foundation","doi-asserted-by":"publisher","award":["320.6750.2024\u20106\u2010113"],"award-info":[{"award-number":["320.6750.2024\u20106\u2010113"]}],"id":[{"id":"10.13039\/100007452","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although C2 pedicle screws are considered the gold standard for atlantoaxial fixation, the optimal fixation strategy for patients with high\u2010riding vertebral arteries (HRVA) or narrow C2 pedicles (NC2P) remains controversial because of the increased risk of vertebral artery injury and the limitations of alternative fixation techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the safety, stability, and clinical efficacy of an individualized C2 screw fixation strategy incorporating vertebral artery mobilization for complex upper cervical anatomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective study was conducted in 312 patients who underwent C2 fixation between 2017 and 2025. Patients were categorized according to fusion method, screw laterality, and VA transposition requirement. Bone fusion rates and screw accuracy (Gertzbein\u2013Robbins grading) were compared across groups using\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      , Fisher's exact, and multivariate logistic regression analyses to control confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All procedures were successfully completed without permanent neurovascular injury. At 6\u2009months, the fusion rate with an atlantoaxial fusion cage was significantly higher than with interlaminar bone grafting (92.3% vs. 51.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Unilateral C2 pedicle screw fixation combined with a contralateral alternative screw achieved comparable stability to bilateral fixation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Screw placement accuracy was 100% clinically acceptable in normal anatomy and 60% in cases requiring VA mobilization, with no VA injury or blood flow compromise.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The proposed multi\u2010strategy C2 screw placement protocol\u2014integrating fusion cage support and VA mobilization\u2014achieves superior fusion, reliable fixation, and high safety, even in anatomically challenging conditions. This approach provides a reproducible and versatile solution for C2 instrumentation in complex craniovertebral junction surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70402","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T03:42:47Z","timestamp":1786160567000},"page":"1892-1903","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Stability of a Combined\n                    <scp>C2<\/scp>\n                    Screw Placement Strategy With Vertebral Artery Mobilization"],"prefix":"10.1111","volume":"18","author":[{"given":"Peng","family":"Song","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangyin","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyuan","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5976-7546","authenticated-orcid":false,"given":"Bo","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Guangyuan Central Hospital  Guangyuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01400872"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200111150-00014"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3171\/SPI\/2008\/8\/3\/230"},{"issue":"12","key":"e_1_2_13_5_1","first-page":"1760","article-title":"Undetected Vertebral Artery Groove and Foramen Variations in C2: A Risk Factor for Pedicle Screw Injury","volume":"13","author":"Yeom J. S.","year":"2013","journal-title":"Spine Journal"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00024720-200404000-00014"},{"issue":"1","key":"e_1_2_13_7_1","first-page":"ONS56","article-title":"C2 Isthmus Screw Fixation Technique","volume":"56","author":"Bristol R. E.","year":"2005","journal-title":"Neurosurgery"},{"issue":"2","key":"e_1_2_13_8_1","first-page":"E427","article-title":"Safe Trajectory of C2 Pedicle Screw Placement","volume":"66","author":"Sim H. B.","year":"2010","journal-title":"Neurosurgery"},{"issue":"2","key":"e_1_2_13_9_1","first-page":"158","article-title":"C2 Spinous Process Screw Fixation: A Novel Technique","volume":"1","author":"Goel A.","year":"2004","journal-title":"Journal of Neurosurgery: Spine"},{"issue":"2","key":"e_1_2_13_10_1","first-page":"292","article-title":"Anatomical Considerations of C2 Vertebra for Transpedicular Screw Fixation","volume":"20","author":"Naderi S.","year":"2013","journal-title":"Journal of Clinical Neuroscience"},{"issue":"3","key":"e_1_2_13_11_1","first-page":"609","article-title":"Comparative Analysis of C2 Pedicle Screw and Pars Screw Fixation in Atlantoaxial Instability With Vertebral Artery Variations","volume":"18","author":"Zhang J.","year":"2021","journal-title":"Neurospine"},{"issue":"5","key":"e_1_2_13_12_1","first-page":"632","article-title":"Quantitative Analysis of Vertebral Artery Distance on CTA","volume":"32","author":"Moftakhar R.","year":"2019","journal-title":"Clinical Anatomy"},{"key":"e_1_2_13_13_1","first-page":"174","article-title":"Morphometry of Vertebral Artery Canal on C2 Using CTA","volume":"72","author":"Agrawal D.","year":"2020","journal-title":"Journal of Clinical Neuroscience"},{"issue":"1","key":"e_1_2_13_14_1","first-page":"3","article-title":"Craniovertebral junction realignment: rationale and technique","volume":"6","author":"Goel A.","year":"2015","journal-title":"Journal of Craniovertebral Junction and Spine"},{"key":"e_1_2_13_15_1","first-page":"e62","article-title":"C2 Vertebral Artery Transposition Technique for Safe Screw Placement","volume":"116","author":"Lee S. H.","year":"2018","journal-title":"World Neurosurgery"},{"issue":"5","key":"e_1_2_13_16_1","first-page":"789","article-title":"Vertebral Artery Mobilization for C2 Pedicle Screw Insertion in HRVA","volume":"20","author":"Hong J. T.","year":"2020","journal-title":"Spine Journal"},{"issue":"1","key":"e_1_2_13_17_1","first-page":"3","article-title":"Use of C1\u20132 Joint Spacers for Atlantoaxial Fusion","volume":"6","author":"Goel A.","year":"2015","journal-title":"Journal of Craniovertebral Junction and Spine"},{"issue":"1","key":"e_1_2_13_18_1","first-page":"88","article-title":"Vertebral Artery Transposition Facilitates Safe C2 Pedicle Screw Placement: A Case Series and Technical Note","volume":"21","author":"Lv Y.","year":"2024","journal-title":"Neurospine"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000051919.14927.57"},{"issue":"1","key":"e_1_2_13_20_1","first-page":"44","article-title":"C2 Screw Fixation Strategies in the Presence of Vertebral Artery Anomalies: Literature Review and Recommendations","volume":"22","author":"Kim C. H.","year":"2025","journal-title":"Neurospine"},{"key":"e_1_2_13_21_1","article-title":"3D Printing\u2010Assisted Planning for C2 Pedicle Screw Fixation in HRVA","volume":"10","author":"Chen Z.","year":"2023","journal-title":"Frontiers in Surgery"},{"issue":"2","key":"e_1_2_13_22_1","first-page":"320","article-title":"Safe Placement of C2 Pedicle Screws in Patients With High\u2010Riding Vertebral Arteries Using 3D Navigation","volume":"27","author":"Wang H.","year":"2018","journal-title":"European Spine Journal"},{"issue":"2","key":"e_1_2_13_23_1","first-page":"217","article-title":"Risk Factors and Management of Vertebral Artery Injury During C2 Pedicle Screw Insertion","volume":"91","author":"Zhang X.","year":"2024","journal-title":"Neurosurgery"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70402","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70402","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:01:16Z","timestamp":1788314476000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/os.70402"],"URL":"https:\/\/doi.org\/10.1111\/os.70402","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"2025-11-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}