Is sectioning of muscle attachment to axis (C2) spinous process mandatory to achieve arthrodesis during atlantoaxial fixation?

The basic and fundamental steps in atlantoaxial fixation technique that was discussed by us in 1994 include the opening of the atlantoaxial joint, denuding of the articular cartilage, and introduction of bone graft within the joint cavity, before plate/rod and monoaxial/polyaxial screw instrumentation.[1‐5] In addition, it was proposed that the muscles attached to the spinous process of axis (C2) should be sharply sectioned. Bone graft is additionally placed in midline over the arch of atlas and lamina of C2 to participate in and to provide added space for bone fusion. The host bone of lamina of C2 and arch of atlas are appropriately prepared by drilling and by denuding of all soft tissues. The combination of these steps appears essential for the success of the operation that is aimed at atlantoaxial arthrodesis.