Biomechanical Comparison of Two Stabilization Techniques of the Atlantoaxial Joints: Transarticular Screw Fixation versus Screw and Rod Fixation

Kuroki, Hiroshi; Rengachary, Setti S.; Goel, Vijay K.; Holekamp, Scott; Pitkänen, Ville; Ebraheim, Nabil A.

doi:10.1227/01.neu.0000144838.01478.35

Cited by 64 publications

(57 citation statements)

References 33 publications

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“…Reported rates of VA injury range from 2 to 5 % [7,22]. Studies have documented that 10-23 % of patients may not be suitable candidates for atlantoaxial transarticular or pedicle screw fixation on at least one side [23][24][25]. In the present study of dry specimens, 11.7 % of C2 pedicles were unsuitable for pedicle screw placement.…”

Section: Discussionmentioning

confidence: 56%

“…In recent years, techniques for short-segment fixation of occipitocervical and atlantoaxial instability have focused on the second cervical vertebra (C2) because of its biomechanical prominence [1][2][3][4]. For example, Magerl and Seemann [3] first described the transarticular screw fixation technique in 1986, and Harms and Melcher [4] introduced the bilateral insertion of polyaxial-head screws into the lateral mass of the first cervical vertebra (C1) and the pedicle of the C2 for C1-C2 fixation.…”

Section: Introductionmentioning

confidence: 99%

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A clinical morphologic study of the C2 pedicle and isthmus

et al. 2012

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Purpose This anatomic, radiographic study investigated locational differences in the C2 pedicle and isthmus [pediculoisthmic component (PIC)] and characterized its narrowest section for clinical application in posterior C2 screw fixation. Methods Structures surrounding the transverse foramina of 30 dry C2s and 10 C3s were compared morphologically. Spinal CT scans of 32 Chinese adults were subjected to volume rendering and multiplanar reconstruction to identify the narrowest C2 PIC, and correlative parameters were measured and analyzed. Results Inferior C2 and C3 structures were morphologically similar. In superior view, the C2 superior facets lay on the transverse foramen and the upper portion between superior and inferior facets was flat (average mediolateral angle, 11.1°± 2.4°). In inferior view, the posteroinferomedial portion of the C2 transverse foramen displayed a partially tubular structure (average mediolateral angle of projection, 42.6°± 4.9°). Average height and width were 11.6 and 6.9 mm. The inner medullary cavity was elliptical and the middle site of endosteal diameter was 3.3 ± 1.9 mm.Medial internal cortical bone was significantly thicker than lateral bone (P \ 0.01). Conclusions The PIC is located between superior and inferior C2 facets. The superior flat area is the isthmus and the inferomedial area connecting the inferior facet and vertebral body is the pedicle. The pedicle is partially tubular and projects posteromedially to the transverse foramen. The narrowest PIC section is the narrowest point of the C2 pedicle. Considering its thin lateral cortical bone, medial and superior pedicle screw placement and preoperative CT reconstruction are recommended.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

A clinical morphologic study of the C2 pedicle and isthmus

et al. 2012

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“…38,40 Wilke et al 37 performed fatigue tests on a single functional spinal unit examining the subsidence with four cervical interbody devices. They performed multi-axis loading (flexion/extension, lateral bending, and axial rotation) under 50 N of compression for 700 cycles.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these limitations, studies have been published on the effect of cyclic loading on the vertebral end plate, 25-29 the intervertebral disk, 30-32 the annulus fibrosis, 33 anterior cervical constructs, 34-37 and on posterior cervical implants. [38][39][40] To our knowledge, little work has been published on the effect of cyclic loading on the interbody implantbone interface.This study was designed to study the biomechanics of the cervical implant-endplate interface before and after cyclic fatigue loading using loads in the physiological range in an attempt to model the subsidence seen …”

mentioning

confidence: 99%

“…Despite these limitations, studies have been published on the effect of cyclic loading on the vertebral end plate, [25][26][27][28][29] the intervertebral disk, [30][31][32] the annulus fibrosis, 33 anterior cervical constructs, [34][35][36][37] and on posterior cervical implants. [38][39][40] To our knowledge, little work has been published on the effect of cyclic loading on the interbody implantbone interface.…”

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confidence: 99%

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Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Ordway

Rim²,

Tan

et al. 2011

Journal Orthopaedic Research

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Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250 N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles. Keywords: cervical endplate; fatigue; cyclic testing; biomechanics; subsidence Anterior cervical fusion has traditionally been a predictable and reliable surgical technique for treatment of multiple spinal pathologies. [1][2][3] The success has been due to factors that are addressed by the surgical procedure: the removal of the pathologic process; the decompression of the neural elements; the correction of sagittal balance; and the stabilization of the motion segment. Maintenance of sagittal balance and continued stabilization of the motion segment following anterior reconstruction is essential in obtaining a successful clinical outcome. Subsidence of an interbody graft or construct prior to bony fusion can be detrimental to sagittal balance and/or stabilization of the motion segment resulting in recurrent foraminal stenosis.Options available for reconstructing the anterior cervical column include a structural autograft, a structural allograft, a carbon fiber cage, a PEEK cage, a titanium mesh cage, or a trabecular metal spacer. Material properties and interface geometries vary, but the devices function similarly by providing mechanical integrity and stability to the construct while bony fusion takes place. Independent of the device, settling occurs following anterior interbody fusion, 4-6 the amount of which is affected by intraoperative endplate injury or removal, osteoporosis, and the cross-sectional area of the implant. 7,8 Obtaining contact between the endplate and implant surfaces is technically challenging, and a certain amount of settling occurs early post-operatively. With bony implants, additional settling occurs as the graft is resorbed prior to bone fusion. The amount of settling is often <1 mm. Other causes of post-op...

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Human Spine, Biomechanics of

Goel

Biyani

Ferrara

et al. 2006

Encyclopedia of Medical Devices and Instrumentation

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The basic anatomy of the human spine is described to highlight the interaction among spinal components that provides the desired function in a normal person. The factors that lead to instability–abnormal motion are described. Abnormal motion may be due to external environmental factors to which the spine is subjected to during activities of daily living (e.g., impact, repetitive loading, lifting) degeneration, infectious diseases, injury or trauma, disorders, and/or surgery. The biomechanics encompasses the mechanical aspects of conservative treatments, surgical procedures and spinal stabilization techniques. These issues are narrated in this article. However, the field of spinal biomechanics is very broad and it is not practical to cover all aspects in one article. For example, this article does not deal with whiplash mechanisms, impact loads, injury biomechnaics due to falls, and in sports to name a few.

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Biomechanical Comparison of Two Stabilization Techniques of the Atlantoaxial Joints: Transarticular Screw Fixation versus Screw and Rod Fixation

Cited by 64 publications

References 33 publications

A clinical morphologic study of the C2 pedicle and isthmus

A clinical morphologic study of the C2 pedicle and isthmus

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Human Spine, Biomechanics of

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