LAUSR

INTRODUCTION Surgical intervention at the craniovertebral junction (CVJ) requires pre-operative and intra-operative planning to get optimum postoperative results. Careful positioning minimizes the risk of iatrogenic injury and can also facilitate adequate surgical exposure. Tortuous venous channels that are usually encountered as the dissection proceeds may cause excessive bleeding before even reaching to the lateral mass (LM). However, both localization and placement may be made easier by altering the dissection technique and by modifying the patient's position. OBJECTIVE Traditionally, military tuck position is described for dorsal approach to the CVJ. The objective of this study is to emphasize the role of arc or bow like position, a modification of prone position for adequate placement of C1 LM screw in these cases. METHODS AND RESULTS 68 patients of atlantoaxial dislocation were operated in an arc or bow position from January 2013 to September 2018. In 58 patients, at least one C1 LM screw was placed. This position helped in easy and early recognition with easy trajectory for the C1 LM screw placement and less work force. CONCLUSION Visual axis to the lateral mass of C1 in arc/bow position with head elevation makes C1 LM more in the visual axis of the operator which makes the trajectory straight without making much angulation while putting the screw. At the same time axis vertebra guides to C1 lateral mass with no handling of dura.