Introduction

The most established surgical technique for posterior screw fixation in the atlas (C1) is realised by screw placement through the lateral mass [1]. This surgical placement may lead to extended bleeding from the paravertebral venous plexus as well as a violation of the axis (C2) nerve roots [1]. Using pedicle screws is an emerging technique which utilises the canal passing through the posterior arch enabling the use of longer screws with a greater contact area while avoiding the venous plexus and axis nerve roots. The aim of this ex vivo study was to investigate if pedicle screws in C1 bear the potential to replace the more common lateral mass screws. Therefore, the comparative biomechanical fixation strengths in terms of cycles to failure, stiffness, and removal torque were investigated.