Impact of 2 different posterior screw fixation techniques on primary stability in a cervical translational injury model

Abstract

Background: In case of injuries to the subaxial cervical spine, especially in osteoporotic bone, the question of the most stable operative technique arises. There are several techniques of screw fixation available regarding dorsal stabilization. This study investigates 2 techniques (lateral mass screws (LMS) vs cervical pedicle screws (CPS)) in the subaxial cervical spine regarding primary stability in a biomechanical testing using a translational injury model.Methods: A total of 10 human formalin fixed and 10 human fresh-frozen specimens (C 4 -T 1) were investigated. Specimens were randomized in 2 groups. Fracture generation of a luxation injury between C 5 and C 6 was created by a transection of all ligamentous structures as well as the intervertebral disc and a resection of the facet joints.Dorsal stabilization of C 4/C 5 to C 6/C 7 was performed in group A by lateral mass screws, in group B by pedicle screws. In the biomechanical testing, the specimens were loaded at 2 N/s in translation direction until implant failure.Results: Formalin fixed specimen: Mean load failure was 513.8 (±86.74) Newton (N) for group A (LMS) and 570.4 (±156.5) N for group B (CPS). There was no significant difference (P = .6905).Fresh frozen specimen: Mean load failure was 402.3 (±96.4) N for group A (LMS) and 500.7 (±190.3) N for group B (CPS). There was no significant difference (P = .4206). Conclusion:In our loading model respecting the translational injury pattern and a flexion movement we could not verify statistically significant differences between lateral mass screws and cervical pedicle screws. Mean loading failure was slightly higher in the CPS group though.Abbreviations: BMD = bone mineral density, CPS = cervical pedicle screws, CT = computed tomography, DXA = dual-energy Xray absorptiometry, LMS = lateral mass screws, N = Newton.

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

“…Comparing the stress changes of the model before and after internal fixation, it can be seen that the nail rod internal fixation system makes the stress transfer of the lumbar spine concentrated on the nail body and reduces the stress load of the lumbar spine's structure, such as the endplate, intervertebral disc, and pedicle, which shows that it can effectively prevent the premature degradation of lumbar-related structures. [31][32][33] The biggest advantage of the pedicle screw rod internal fixation system is that it produces immediate stability, which provides a prerequisite for patients to carry out postoperative rehabilitation training and related functional exercises as soon as possible, which is particularly important for the functional recovery of surgical patients. [34][35][36] However, by observing the force on the posterior internal fixation system under different states, the placement of the screw rod internal fixation caused excessive stress concentrated on the pedicle screw.…”