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However, with a high-riding VA, the entry point needs to be shifted medially. C1 lateral mass screws were inserted according to the standard technique and fixed to C2 screws with rods. Postoperatively, the patient improved and radiology showed satisfactory reduction with good flow across the VA on angiography. There is a minimal risk of arterial injury/spasm due to its handling. Nevertheless, the benefit of a strong construct clearly outweighs this risk. Alternatively, one may insert a C2 laminar screw. However, the biomechanical conside
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