Finite element analysis.
To determine and compare the biomechanical stability of the bicortical short C2 pars screw fixation for high-riding vertebral artery (HRVA) with the C2 pedicle screw and C2 translaminar screw fixation in finite element models.
Fixation of C2 is technically demanding in the case of HRVA. However, there is no consensus on the alternative technique for the C2 screw fixation for HRVA in the literature.
A finite element (FE) model of the upper cervical spine (C0-C2) with HRVA had been developed. C1 pedicle screw was applied at C1 by using notching technique. Bicortical short C2 pars screws, C2 pedicle screws, and C2 translaminar screws were used in each model. Then a vertical load of 50 N and a 1.5 Nm torque were applied to the C0 to simulate flexion, extension, lateral bending, and axial rotation respectively.
Compared with C2 pedicle screw fixation, the bicortical short C2 pars screw fixation increased the range of motion (ROM) by -1.45%, 2.13%, 62.0%, and 22.0% under flexion, extension, lateral bending, and axial rotation, respectively; However, the C2 translaminar screw fixation increased the ROM by 43.6%, 17.8%, 423.4%, and 19.9%, respectively. In terms of the peak von Mises stress, compared with C2 pedicle screw fixation, bicortical short C2 pars screw decreased 46.1%, 41.6%, 71.3%, and -12.5% under flexion, extension, lateral bending, and axial rotation, respectively; C2 translaminar screw decreased -2.66%, -4.87%, 73.0% and -10.1%, respectively.
For a patient with HRVA, bicortical short C2 pars screw fixation provides sufficient stability and exhibited a smaller von Mises distribution on the screw-rod construct, indicating it could be an effective C2 internal fixation method for HRVA to promote C1-C2 stability and avoid the vertebral artery injury.Level of Evidence: N/A.

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