Biomechanical comparison of anterior Caspar plate and three-level posterior fixation techniques in a human cadaveric model

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✓ Traumatic cervical spine injuries have been successfully stabilized with plates applied to the anterior vertebral bodies. Previous biomechanical studies suggest, however, that these devices may not provide adequate stability if the posterior ligaments are disrupted. To study this problem, the authors simulated a C-5 teardrop fracture with posterior ligamentous instability in human cadaveric spines. This model was used to compare the immediate biomechanical stability of anterior cervical plating, from C-4 to C-6, to that provided by a posterior wiring construct over the same levels. Stability was tested in six modes of motion: flexion, extension, right and left lateral bending, and right and left axial rotation. The injured/plate-stabilized spines were more stable than the intact specimens in all modes of testing. The injured/posterior-wired specimens were more stable than the intact spines in axial rotation and flexion. They were not as stable as the intact specimens in the lateral bending or extension testing modes. The data were normalized with respect to the motion of the uninjured spine and compared using repeated measures of analysis of variance, the results of which indicate that anterior plating provides significantly more stability in extension and lateral bending than does posterior wiring. The plate was more stable than the posterior construct in flexion loading; however, the difference was not statistically significant. The two constructs provide similar stability in axial rotation. This study provides biomechanical support for the continued use of bicortical anterior plate fixation in the setting of traumatic cervical spine instability.

Article Information

Address reprint requests to: Vijay K. Goel, Ph.D., Department of Biomedical Engineering, University of Iowa, 1202A Engineering Building, Iowa City, Iowa 52242.

© AANS, except where prohibited by US copyright law.

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Figures

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    Schematic representation of a cadaveric spine prepared for testing.

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    Drawings of the injury model. A teardrop fracture of C-5 is simulated with an osteotome cut through the anterior inferior C-5 body; all posterior ligaments (except the posterior longitudinal ligament) are incised.

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    Upper: Illustrations showing injured vertebral bodies replaced with a strut graft (left) and stabilized with an anterior cervical plate (right). Lower: Drawings showing two stages of a procedure to stabilize an injured specimen with posterior wiring. An anterior strut graft is present (not visualized).

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    Illustration showing the Cartesian axis coordinates used in the data analysis in this study.

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    Load-deformation curves showing the axial rotation of an intact specimen (left), an injured specimen stabilized with an anterior plate (center), and an injured specimen with posterior wire stabilization (right).

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    Graph showing average normalized relative rotations at maximum load of the injured/stabilized spines. LAR = left axial rotation: RAR = right axial rotation; LLB = left lateral bending; RLB = right lateral bending; FLX = flexion; EXT = extension.

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