Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique

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Object. The authors compared the biomechanical stability resulting from the use of a new technique for occipitoatlantal motion segment fixation with an established method and assessed the additional stability provided by combining the two techniques.

Methods. Specimens were loaded using nonconstraining pure moments while recording the three-dimensional angular movement at occiput (Oc)—C1 and C1–2. Specimens were tested intact and after destabilization and fixation as follows: 1) Oc—C1 transarticular screws plus C1–2 transarticular screws; 2) occipitocervical transarticular (OCTA) plate in which C1–2 transarticular screws attach to a loop from Oc to C-2; and (3) OCTA plate plus Oc—C1 transarticular screws.

Occipitoatlantal transarticular screws reduced motion to well within the normal range. The OCTA loop and transarticular screws allowed a very small neutral zone, elastic zone, and range of motion during lateral bending and axial rotation. The transarticular screws, however, were less effective than the OCTA loop in resisting flexion and extension.

Conclusions. Biomechanically, Oc—C1 transarticular screws performed well enough to be considered as an alternative for Oc—C1 fixation, especially when instability at C1–2 is minimal. Techniques for augmenting these screws posteriorly by using a wired bone graft buttress, as is currently undertaken with C1–2 transarticular screws, may be needed for optimal performance.

Article Information

Address reprint requests to: Neil R. Crawford, Ph.D., Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road; Phoenix, Arizona 85013–4496. email: ncrawfo@chw.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Artist's drawings. Anteroposterior (upper) and lateral (lower) views of placement of the occipitoatlantal transarticular screws.

  • View in gallery

    Photograph of the OCTA device for occipitoatlantoaxial fixation. Transarticular screws crossing the C1–2 joint have U-shaped connectors on their heads. A loop mounted to the skull base interconnects rigidly with the U-shaped connectors.

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    Photograph of specimen held in a silicone mold to maintain its normal neutral alignment after destabilization and during screw insertion.

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    Anteroposterior (upper) and lateral (lower) radiographs demonstrating the trajectories of Oc—C1 transarticular screws and C1–2 transarticular screws in a cadaveric specimen.

  • View in gallery

    Graphs. Left: Angular motion at Oc—C1 for each construct studied. Horizontal lines on each column demarcate NZ from EZ (NZ closer to 0). Full columns represent ROM, which is the sum of the NZ and EZ. Error bars show SD of the ROM. Right: Angular motion at C1–2 for each construct studied. Horizontal lines on each column demarcate NZ from EZ (NZ closer to 0). Full columns represent ROM, which is the sum of the NZ and EZ. Error bars show SD of the ROM.

  • View in gallery

    Left: Preoperative coronal computerized tomography reconstruction revealing widening between the occipital condyle and the lateral mass of the axis. Right: Postoperative lateral radiograph demonstrating the position of the screw and the solid bone fusion in the back, held with sublaminar wiring.

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