Transarticular screw fixation (TASF) is an accepted surgical treatment for pathologic C1-C2 instability due to trauma, ligamentous laxity or degenerative disorders. Previous biomechanical tests have found C1-C2 TASF with a posterior graft to have increased rotational and shear stiffness, as compared with posterior wiring techniques. A complete mechanical analysis of the C1-C2 TASF construct was performed to determine the primary mode of loading. The greatest stress placed on the fixated C1-C2 motion segment was a bending stress developed during flexion and extension.

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