For C1 tumors, C2 is instrumented bilaterally.
For C2 tumors, the C2 level is rarely included in the instrumentation. However, if the tumor is unilateral, the contralateral side may be instrumented upon surgeon's preference.
For C2 fixation the following options are available (in order of preference):
A consideration is given to use pedicle or laminar screws when doing an occiput to C2 fusion as oftentimes the starting point for the pars screws may compromise the facet joint.