One of the most technically demanding cervical spine surgeries is stabilizing the second bone of the next (C2, or "axis"). This is because the vertebral arteries wrap around the second bone, carrying blood to the brain and upper spinal cord.
Traditional methods of placing screws into C2 involved passing the screw very close to the vertebral artery. This methods include C2 pedicle screws and C1-2 transarticular screws. Even with intra-operative imaging and with careful surgical technique, these techniques are associated with a small risk of injury to the vertebral artery, with the potential risk of a major stroke. Dr. Wright reported on this in 1998
Wright, N.M., and Lauryssen, C. Vertebral artery injury in C1/2 transarticular screw fixation: results of a survey of the AANS/CNS joint section on disorders of the spine and peripheral nerves. Journal of Neurosurgery 4(88):634-40, 1998.
In 2003, Dr. Wright developed a new technique of screw fixation of C2, which does not place the screw near the vertebral artery. This technique is now popular world-wide and is known as the "Wright technique". There has never been a report of a vertebral artery injury with this technique!
Wright, N.M. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. Journal of Spinal Disorders and Techniques 17(2):158-162, 2004. [cited by more than 100 articles on PubMed]
Cited as paper #75 in The 100 Most Influential Spine Fracture Publications. J Spine Surg 5(1):97-107, 2019.
Computed tomography morphometric analysis of C2 translaminar screw fixation of Wright's technique and a modified technique in the pediatric cervical spine.
Xia DD, Lin SL, Chen W, Shen ZH, Li Y, Wang XY, Xu HZ, Chi YL. Eur Spine J. 2014 Mar;23(3):606-12. doi: 10.1007/s00586-013-3130-9. Epub 2013 Dec 12.
PMID: 24337233
Kabir SM, Casey AT. Acta Neurochir (Wien). 2009 Nov;151(11):1543-7. doi: 10.1007/s00701-009-0459-2. Epub 2009 Aug 6.
PMID: 19657582
Modification of Wright's technique for placement of bilateral crossing C2 translaminar screws: technical note.
Jea A, Sheth RN, Vanni S, Green BA, Levi AD. Spine J. 2008 Jul-Aug;8(4):656-60. Epub 2007 Jul 30.
PMID: 17938004
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