Biomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability

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Object. The authors compared the biomechanical stability of two anterior fixation procedures—anterior C1–2 Harms plate/screw (AHPS) fixation and the anterior C1–2 transarticular screw (ATS) fixation; and two posterior fixation procedures—the posterior C-1 lateral mass combined with C-2 pedicle screw/rod (PLM/APSR) fixation and the posterior C1–2 transarticular screw (PTS) fixation after destabilization.

Methods. Sixteen human cervical spine specimens (Oc—C3) were tested in three-dimensional flexion—extension, axial rotation, and lateral bending motions after destabilization by using an atlantoaxial C1–2 instability model. In each loading mode, moments were applied to a maximum of 1.5 Nm, and the range of motion (ROM), neutral zone (NZ), and elastic zone (EZ) were determined and values compared using the intact spine, the destabilized spine, and the postfixation spine.

The AHPS method produced inferior biomechanical results in flexion—extension and lateral bending modes compared with the intact spine. The lateral bending NZ and ROM for this method differed significantly from the other three fixation techniques (p < 0.05), although statistically significant differences were not obtained for all other values of ROM and NZ for the other three procedures. The remaining three methods restored biomechanical stability and improved it over that of the intact spine.

Conclusions. The PLM/APSR fixation method was found to have the highest biomechanical stiffness followed by PTS, ATS, and AHPS fixation. The PLM/APSR fixation and AATS methods can be considered good procedures for stabilizing the atlantoaxial joints, although specific fixation methods are determined by the proper clinical and radiological characteristics in each patient.

Article Information

Address reprint requests to: Daniel H. Kim, M.D., Department of Neurosurgery, Stanford University Medical Center, Room R-201, Edwards Building, 300 Pasteur Drive, Stanford, California 94305–5327. email: neurokim@stanford.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Biomechanical test setup showing the spine fixture of the MTS loading frame. Three-dimensional displacement of each motion segment was measured using two linear extensometers.

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    Radiographic features of four different fixation methods of the atlantoaxial segment after odontoidectomy (anterposterior [left] and lateral [right] views). A: Anterior transarticular screw fixation. B: Posterior transarticular screw fixation. C: Anterior Harms plate/screw fixation. D: Posterior C-1 lateral mass and C-2 pedicle screw rod fixation.

  • View in gallery

    Bar graphs demonstrating normalized Oc—C3 motion data of the destabilized and the instrumented spine. Left: Normalized ROM. Right: Normalized NZ. AH = AHPS fixation; AT = ATS fixation; PP = PLM/APSR fixation; PT = PTS fixation. Error bar denotes one SD.

  • View in gallery

    Bar graphs showing normalized C1–2 motion data of the destabilized and the instrumented spine. Left: Normalized ROM. Right: Normalized NZ. Error bar denotes one SD.

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