{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:07Z","timestamp":1787028667953,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Fractures of the upper cervical spine are challenging to treat due to their proximity to critical neurovascular structures and the need for immediate, stable fixation. Open posterior fixation remains the standard but is associated with soft-tissue disruption and morbidity. Minimally invasive, navigation-assisted pedicle screw fixation represents a viable alternative for older populations, significantly reducing surgical morbidity and tissue trauma. The present study evaluates the accuracy, safety, and perioperative outcomes of minimally invasive navigated posterolateral C1\u2013C2 fixation. Methods: We conducted a retrospective consecutive case review of 51 patients who underwent minimally invasive C1\u2013C2 screw fixation between 2019 and 2024. All procedures were performed using intraoperative O-arm imaging and StealthStation S8 navigation. Screw placement accuracy was assessed using the Bredow modification of the Gertzbein\u2013Robbins and Heary classifications. Perioperative data, including operative time, screw dimensions, radiation dose, complications, and hospital stay, were recorded. Results: Fifty-one patients were included in the study. A total of 212 screws were placed. According to Gertzbein\u2013Robbins grading, 92.4% were Grade A, 6.6% were Grade B, and 1% were Grade C. According to Heary grading, 95% were Grade I and 5% were Grade III. No vertebral artery injuries, new neurological deficits, or intraoperative hardware failures occurred. The mean screw lengths were 33.2 mm (SD = 3.38 mm) (C1) and 32 mm (SD = 4.30 mm) (C2). The mean operative time was 128 min (SD = 52.95 min). The mean radiation dose was 629.16 mGy\u00b7cm2 (SD = 372.2 mGy\u00b7cm2). One superficial wound infection occurred. The median postoperative NRS was 4 (IQR: 4\u20135). The mean hospital stay was 4.21 (SD = 3.77) days. Conclusions: Our findings demonstrate that the presented approach for C1\u2013C2 fixation is a highly accurate and safe alternative to open posterior fixation for upper cervical fractures.<\/jats:p>","DOI":"10.3390\/jcm15114373","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T08:43:04Z","timestamp":1780648984000},"page":"4373","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Minimally Invasive, CT Neuronavigated Posterolateral Pedicle Screw Placement in Upper Cervical Spine: A Retrospective Accuracy and Safety Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1302-6619","authenticated-orcid":false,"given":"Piotr","family":"Stogowski","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanis\u0142aw","family":"Adamski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakub","family":"Wi\u015bniewski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"W\u0119clewicz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru\u0144, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar","family":"Liczbik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patryk","family":"Kurlandt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Czauderna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonasz","family":"Tempski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3094-2385","authenticated-orcid":false,"given":"Mateusz","family":"Szczupak","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Kobak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Faculty of Medicine, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Wasilewski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-3410","authenticated-orcid":false,"given":"Wojciech","family":"Kloc","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nicolaus Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"},{"name":"Department of Health, WSB Merito University in Gda\u0144sk, 80-266 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40621-022-00374-w","article-title":"Epidemiology of traumatic cervical spinal fractures in a general Norwegian population","volume":"9","author":"Utheim","year":"2022","journal-title":"Inj. 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