Dissection for C1 lateral mass screw insertion
If C1 lateral mass screws are planned, reflect the C2 nerve root and its associated veins caudally. This dissection can result in severe bleeding and must therefore be performed with great care.
Using a Penfield 4 dissector, gently push the C2 nerve root off of the caudal border of the posterior arch of C1 until the lateral mass can be palpated with the Penfield 4.
If bleeding is encountered, pack it off with Gelfoam soaked in thrombin together with a small paddy. Leave it in place and expose the other side. When/if bleeding is encountered on the contralateral side, continue the dissection on the ipsilateral side.