Computed Tomography and Biomechanical Comparison between Trans-Articular Screw Fixation and 2 Polymethylmethacrylate Cemented Constructs for Ventral Atlantoaxial Stabilization

Leblond, Guillaume; Moens, Noël M. M.; Gaitero, Luís; Linden, Alex zur; James, Fiona; Monteith, Gabrielle; Runciman, R. John

doi:10.1055/s-0038-1661397

Cited by 2 publications

(4 citation statements)

References 33 publications

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“…Leblond et al 26 also evaluated the rigidity of a few stabilization methods under physiological conditions. They found no significant difference between their three experimental groups (transarticular screws and two different cemented constructions), whereas in the present study the cemented construction proved to be significantly more rigid than the other methods, although all four techniques were able to support the predefined load without failing.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, it is likely that the specific placement of the implants is responsible for the biomechanical advantages of the cemented construction, as the force concentration point of the atlantoaxial region tends to be located in the cranial portion of the axis 29 , 30 . The presence of screws and bone cement along the entire surface of the vertebral body of C2 better distributes the loads transmitted in this region, making the cemented construct better able to support flexion loads 26 . The implants in the configurations of transarticular lag screws, atlantoaxial plate and polyaxial screws are concentrated in the cranial portion of the axis, in which forces are concentrated, and thus bear significantly lower loads.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, dogs of any age, size and breed can be affected by traumatic AAS. In addition, previous biomechanical studies involving atlantoaxial stabilization use Beagle dogs as models 3 , 8 , 26 . So, our study allows for more reliable comparisons between the results.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are many descriptions of AAS stabilization techniques, few biomechanical studies have been performed 3 , 8 , 26 , so there is little information to guide the neurosurgeon in choosing the safest atlantoaxial stabilization technique. The aim of this study was to compare, through biomechanical evaluation under ventral flexion load, four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs: transarticular lag screws, polyaxial screws, multiple screws and PMMA, and a new atlantoaxial plate.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical evaluation of four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs

Ferreira,

Dias,

Minto

et al. 2023

Acta Cir. Bras.

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Purpose: This study compared, through biomechanical evaluation under ventral flexion load, four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs. Methods: In total, 28 identical atlantoaxial joint models were created by digital printing from computed tomography images of a dog, and the specimens were divided into four groups of seven. In each group, a different technique for ventral stabilization of the atlantoaxial joint was performed: transarticular lag screws, polyaxial screws, multiple screws and bone cement (polymethylmethacrylate–PMMA), and atlantoaxial plate. After the stabilization technique, biomechanical evaluation was performed under ventral flexion load, both with a predefined constant load and with a gradually increasing load until stabilization failure. Results: All specimens, regardless of stabilization technique, were able to support the predefined load without failing. However, the PMMA method provided significant more rigidity (p ≤ 0.05) and also best resisted the gradual increase in load, supporting a significantly higher maximum force (p ≤ 0.05). There was no statistical difference in flexural strength between the transarticular lag screws and plate groups. The polyaxial screws method was significantly less resistant to loading (p ≤ 0.05) than the other groups. Conclusions: The PMMA technique had biomechanical advantages in ventral atlantoaxial stabilization over the other evaluated methods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Biomechanical evaluation of four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs

Ferreira,

Dias,

Minto

et al. 2023

Acta Cir. Bras.

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Atlanto‐axial ventral stabilisation using 3D‐printed patient‐specific drill guides for placement of bicortical screws in dogs

Toni

Oxley

Behr

2020

J of Small Animal Practice

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To report outcome and complications following atlanto-axial stabilisation by polymethylmethacrylate applied to screws placed using 3D-printed patient-specific drill guides. Materials and MethOds: Case series of dogs treated with this technique between May 2016 and August 2018 including pre-and post-operative modified Frankel score, imaging and complications. Screw placement was graded using a modified Zdichavsky classification based on post-operative CT. Telephone follow-up was obtained for surviving dogs. results: Twelve cases were included. At presentation, modified Frankel score was 3 in five dogs and 4 in seven dogs on presentation. Of 61 bicortical screws placed, 57 (93%) were fully contained within the pedicle and vertebral body and four (7%) partially breached the medial pedicle wall. Post-operative CT revealed good alignment of C1 and C2 in all planes. Reversible perioperative adverse events were described in five of 12 dogs and two dogs were euthanased shortly after discharge. At 18 to 50 days after surgery eight dogs had improved neurological status. Neurological status remained unchanged in the remaining two dogs. All dogs were reported ambulatory and pain-free at telephone follow-up (median 405 days post-surgery, range 180 to 780 days). clinical significance: This technique resulted in safe bicortical screw placement in dogs with atlantoaxial subluxation.

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Computed Tomography and Biomechanical Comparison between Trans-Articular Screw Fixation and 2 Polymethylmethacrylate Cemented Constructs for Ventral Atlantoaxial Stabilization

Abstract: This study provides evidence that all three techniques are technically feasible and biomechanically viable but also that the evaluated surgical guidelines could be improved.

Cited by 2 publications

References 33 publications

Biomechanical evaluation of four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs

Biomechanical evaluation of four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs

Atlanto‐axial ventral stabilisation using 3D‐printed patient‐specific drill guides for placement of bicortical screws in dogs

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