Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Injuries of the subaxial cervical spine including facet joints and posterior ligaments are common. Potential surgical treatments consist of anterior, posterior, or anterior-posterior fixation. Because each approach has its advantages and disadvantages, the best treatment is debated. This biomechanical cadaver study compared the effect of different facet joint injuries on primary stability following anterior plate fixation.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Fractures and plate fixation were performed on 15 fresh-frozen intact cervical spines (C3–T1). To simulate a translation-rotation injury in all groups, complete ligament rupture and facet dislocation were simulated by dissecting the entire posterior and anterior ligament complex between C-4 and C-5. In the first group, the facet joints were left intact. In the second group, one facet joint between C-4 and C-5 was removed and the other side was left intact. In the third group, both facet joints between C-4 and C-5 were removed. The authors next performed single-level anterior discectomy and interbody grafting using bone material from the respective thoracic vertebral bodies. An anterior cervical locking plate was used for fixation. Continuous loading was performed using a servohydraulic test bench at 2 N/sec. The mean load failure was measured when the implant failed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In the group in which both facet joints were intact, the mean load failure was 174.6 ± 46.93 N. The mean load failure in the second group where only one facet joint was removed was 127.8 ± 22.83 N. In the group in which both facet joints were removed, the mean load failure was 73.42 ± 32.51 N. There was a significant difference between the first group (both facet joints intact) and the third group (both facet joints removed) (p &lt; 0.05, Kruskal-Wallis test).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In this cadaver study, primary stability of anterior plate fixation for dislocation injuries of the subaxial cervical spine was dependent on the presence of the facet joints. If the bone in one or both facet joints is damaged in the clinical setting, anterior plate fixation in combination with bone grafting might not provide sufficient stabilization; additional posterior stabilization may be needed.</jats:p></jats:sec>

A biomechanical analysis of anterior cervical discectomy and fusion alone or combined cervical fixations in treating compression-extension injury with unilateral facet joint fracture: a finite element study

“…The C4/C5 segment from this model was extracted and analyzed. The reason for choosing the C4/C5 motion segment involved that the large amount of facet injuries commonly occurred on this joint in clinical practice, its use in previous cervical spine models, and its similarity to other segments in the full spine model [ 15 , 16 ]. Our previous study have showed validation of the C4/C5 FE model in detail by comparing with the experimental data obtained from normal cadaver and published data reported in the literatures [ 12 , 17 – 19 ].…”

Spondylodesetechniken dorsal

“…Trotz alledem gilt es, im Falle einer traumatisch bedingten Instabilität im subaxialen Bereich diese Verletzungen zu detektieren, bei denen primär das dorsale Vorgehen indiziert ist [14]. Hier handelt es sich um Verletzungen vom Typ C oder B mit Luxationen der kleinen Wirbelgelenke, bei denen eine ventrale Reposition nicht möglich ist oder von dorsal primär eine Dekompression erforderlich wird (▶ Abb.…”

Circumferential Reconstruction of Subaxial Cervical and Cervicothoracic Spine by Simultaneously Combined Anterior–posterior Approaches in the Sitting Position

“…Loss of postoperative alignment occurred in 13% of subjects. In a biomechanical cadaver study, Oberkircher et al . compared the effect of different facet joint injuries on primary stability following anterior plate fixation.…”