Biomechanical comparison between C-7 lateral mass and pedicle screws in subaxial cervical constructs

Presented at the 2009 Joint Spine Meeting 

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Object

The aim of this study was to conduct the first in vitro biomechanical comparison of immediate and postcyclical rigidities of C-7 lateral mass versus C-7 pedicle screws in posterior C4–7 constructs.

Methods

Ten human cadaveric spines were treated with C4–6 lateral mass screw and C-7 lateral mass (5 specimens) versus pedicle (5 specimens) screw fixation. Spines were potted in polymethylmethacrylate bone cement and placed on a materials testing machine. Rotation about the axis of bending was measured using passive retroreflective markers and infrared motion capture cameras. The motion of C-4 relative to C-7 in flexion-extension and lateral bending was assessed uninstrumented, immediately after instrumentation, and following 40,000 cycles of 4 Nm of flexion-extension and lateral bending moments at 1 Hz. The effect of instrumentation and cyclical loading on rotational motion across C4–7 was analyzed for significance.

Results

Preinstrumented spines for the 2 cohorts were comparable in bone mineral density and range of motion in both flexion-extension (p = 0.33) and lateral bending (p = 0.16). Lateral mass and pedicle screw constructs significantly reduced motion during flexion-extension (11.3°–0.26° for lateral mass screws, p = 0.002; 10.51°–0.30° for pedicle screws, p = 0.008) and lateral bending (7.38°–0.27° for lateral mass screws, p = 0.003; 11.65°–0.49° for pedicle screws, p = 0.03). After cyclical loading in both cohorts, rotational motion over C4–7 was increased during flexion-extension (0.26°–0.68° for lateral mass screws; 0.30°–1.31° for pedicle screws) and lateral bending (0.27°–0.39° and 0.49°–0.80°, respectively), although the increase was not statistically significant (p > 0.05). There was no statistical difference in postcyclical flexion-extension (p = 0.20) and lateral bending (0.10) between lateral mass and pedicle screws.

Conclusions

Both C-7 lateral mass and C-7 pedicle screws allow equally rigid fixation of subaxial lateral mass constructs ending at C-7. Immediately and within a simulated 6-week postfixation period, C-7 lateral mass screws may be as effective as C-7 pedicle screws in biomechanically stabilizing long subaxial lateral mass constructs.

Abbreviation used in this paper: DEXA = dual energy x-ray absorptiometry.

Article Information

Address correspondence to: Ali Bydon, M.D., 600 North Wolfe Street, Meyer 7-109, Baltimore, Maryland 21287. email: abydon1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Posterior-anterior and lateral fluoroscopy views demonstrating C4–7 posterior constructs utilizing lateral mass screws (a and b) or pedicle screws (c and d) at C-7. Lateral mass screws were used at C4–6 in both groups.

  • View in gallery

    Bar graph showing the mean rotational motion (degrees) of C-4 on C-7 during 4 Nm of uniaxial pure moment flexion-extension for lateral mass screw versus pedicle screw fixation at C-7 in subaxial cervical constructs. Lateral mass screw fixation provided significantly (p = 0.002) decreased range of motion compared with preinstrumented spines, and this rigidity was maintained after the cycling protocol. Similarly, pedicle screw fixation also provided significantly (p = 0.003) decreased range of motion compared with preinstrumented spines, and this rigidity was also maintained after the cycling protocol. Although postcycling rotational motion increased slightly compared with immediate postinstrumentation motion for both lateral mass and pedicle screw fixation, this was not statistically significant (p > 0.05).

  • View in gallery

    Bar graph showing the mean rotational motion (degrees) of C-4 on C-7 during 4 Nm of uniaxial pure moment lateral bending for lateral mass screw fixation at C-7 in subaxial cervical constructs. Lateral mass screw fixation provided significantly (p = 0.008) decreased range of motion compared with preinstrumented spines. Similarly, pedicle screw fixation also provided significantly (p = 0.03) decreased range of motion compared with preinstrumented spines. For both types of instrumentation, this rigidity was maintained even after the cycling protocol. Although postcycling rotational motion increased slightly compared with immediate postinstrumentation motion, this increase was not statistically significant (p > 0.05).

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