A Semispinalis Cervicis-Sparing Intermuscular Approach for C2-3 Posterior Fixation.

BACKGROUND AND IMPORTANCE: Preservation of the semispinalis cervicis insertion at the C2 spinous process is important for maintaining cervical extensor function and postoperative alignment. However, muscle-preserving approaches for posterior fixation at the C2-3 level remain technically challenging. CLINICAL PRESENTATION: A 66-year-old man with a traumatic hangman's fracture underwent posterior C2-3 fixation using a semispinalis cervicis-sparing intermuscular approach. A natural connective tissue plane between the semispinalis capitis and semispinalis cervicis was developed, allowing exposure of C2 and C3 without detaching the semispinalis cervicis insertion. Instrumentation was successfully performed under intraoperative computed tomography-based navigation. Postoperative pain was minimal, and stable fixation was achieved without complications. CONCLUSION: This case demonstrates that the semispinalis cervicis-sparing intermuscular approach provides a feasible muscle-preserving corridor for C2-3 fixation and may represent a useful alternative in selected patients.