Surgical TechniqueThe C2 “Parsicle” Screw Introduction of a Novel Posterior Surgical Technique For Upper Cervical FixationKepler, Christopher C. MD, MBA; Fang, Taolin MD, PhD; Bronson, Wesley H. MD; Russo, Glenn S. MD; Schroeder, Gregory D. MDAuthor Information Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA Dr. Schroeder has received funds to travel from AOSpine and Medtronic. The remaining authors declare no conflict of interest. Reprints: Christopher C. Kepler, MD, MBA, Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 (e-mail: email@example.com). Received May 13, 2018 Accepted October 24, 2018 Online date: August 20, 2019 Clinical Spine Surgery: May 2020 - Volume 33 - Issue 4 - p 146-149 doi: 10.1097/BSD.0000000000000871 Buy SDC Metrics Abstract The instrumentation of C2 is technically challenging given the anatomic complexity of the upper cervical spine. Although the placement of C2 pedicle screws may be safer than transarticular screw placement, the inconsistent location of the transverse foramen and vertebral artery precludes placement of such screws in up to 26% of patients. In cases where vertebral artery anatomy prevents the safe placement of a pedicle screw, a pars screw is an excellent alternative. However, pars screws must stop short of the vertebral foramen, limiting the typical length of these screws to only 14–18 mm. The associated purchase and rigidity are compromised compared with the pedicle screw. A modified C2 fixation technique was developed by our group which we have named the C2 “parsicle” screw reflecting the hybrid nature of the screw incorporating aspects of pars and pedicle screw fixation. © 2020 by Lippincott Williams & Wilkins, Inc.