Biomechanical Evaluations of Various C1-C2 Posterior Fixation Techniques

Sim, Hong Bo; Lee, Jong Won; Park, Jong-Tae; Mindea, Stefan A.; Lim, Ji Eun; Park, Jon

doi:10.1097/brs.0b013e31820611ba

Cited by 92 publications

(79 citation statements)

References 23 publications

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“…Sim et al 40 reported that the C1-C2TA construct provided better biomechanical stabilization than the C1LM-C2PS construct in flexion/extension only, whereas Guo et al 15 reported better stabilization in axial rotation only. Li et al, 28 Hott et al, 19 and Ma et al 29 did not find significant differences in the stabilization achieved with the C1-C2TA and C1LM-C2PS constructs in any degree of motion.…”

Section: Discussionmentioning

confidence: 99%

“…Meta-analysis was performed for C1-2 transarticular screw (C1-C2TA [n = 5]), 15,19,25,29,38,39 C1 lateral mass-C2 pedicle screw (C1LM-C2PS [n = 10]), 7,15,19,25,27,29,34,37,40 C1LM-C2TL (n = 3), 7,27,40 and C1LM-C2 pars (n = 3) constructs. 7,23 Anterior-approach transarticular screw and C1 lateral mass-C3 lateral mass screw constructs were excluded from the meta-analysis because each technique was reported only once in the included articles.…”

Section: Screw Constructsmentioning

confidence: 99%

“…3,7,9,15,19,23,25,[27][28][29]34,[37][38][39][40] Fixation procedures were performed on a total of 134 cadaveric specimens, with an average (± SD) of 7.4 ± 1.8 specimens per study (range 5-12). The spinal levels of the cadavers potted were occiput-C2 (n = 7), C1-2 (n = 10), occiput-C3 (n = 38), occiput-C4 (n = 57), and occiput-C5 (n = 12).…”

Section: Cadaveric Model Characteristicsmentioning

confidence: 99%

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Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis

Du¹,

Aichmair²,

Kueper³

et al. 2015

SPI

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OBJECT The unique and complex biomechanics of the atlantoaxial junction make the treatment of C1–2 instability a challenge. Several screw-based constructs have been developed for atlantoaxial fixation. The biomechanical properties of these constructs have been assessed in numerous cadaver studies. The purpose of this study was to systematically review the literature on the biomechanical stability achieved using various C1–2 screw constructs and to perform a meta-analysis of the available data. METHODS A systematic search of PubMed through July 1, 2013, was conducted using the following key words and Boolean operators: “atlanto [all fields]” AND “axial [all fields]” OR “C1–C2” AND “biomechanic.” Cadaveric studies on atlantoaxial fixation using screw constructs were included. Data were collected on instability models, fixation techniques, and range of motion (ROM). Forest plots were constructed to summarize the data and compare the biomechanical stability achieved. RESULTS Fifteen articles met the inclusion criteria. An average (± SD) of 7.4 ± 1.8 cadaveric specimens were used in each study (range 5–12). The most common injury models were odontoidectomy (53.3%) and cervical ligament transection (26.7%). The most common spinal motion segments potted for motion analysis were occiput–C4 (46.7%) and occiput–C3 (33.3%). Four screw constructs (C1 lateral mass–C2 pedicle screw [C1LM–C2PS], C1–2 transarticular screw [C1–C2TA], C1 lateral mass–C2 translaminar screw [C1LM-C2TL], and C1 lateral mass–C2 pars screw [C1LM–C2 pars]) were assessed for biomechanical stability in axial rotation, flexion/extension, and lateral bending, for a total of 12 analyses. The C1LM–C2TL construct did not achieve significant lateral bending stabilization (p = 0.70). All the other analyses showed significant stabilization (p < 0.001 for each analysis). Significant heterogeneity was found among the reported stabilities achieved in the analyses (p < 0.001; I2 > 80% for all significant analyses). The C1LM–C2 pars construct achieved significantly less axial rotation stability (average ROM 36.27° [95% CI 34.22°–38.33°]) than the 3 other constructs (p < 0.001; C1LM–C2PS average ROM 49.26° [95% CI 47.66°–50.87°], C1–C2TA average ROM 47.63° [95% CI 45.22°–50.04°], and C1LM–C2TL average ROM 53.26° [95% CI 49.91°–56.61°]) and significantly more flexion/extension stability (average ROM 13.45° [95% CI 10.53°–16.37°]) than the 3 other constructs (p < 0.001; C1LM–C2PS average ROM 9.02° [95% CI 8.25°–9.80°], C1–C2TA average ROM 7.39° [95% CI 5.60°–9.17°], and C1LM–C2TL average ROM 7.81° [95% CI 6.93°–8.69°]). The C1–C2TA (average ROM 5.49° [95% CI 3.89°–7.09°]) and C1LM–C2 pars (average ROM 4.21° [95% CI 2.19°–6.24°]) constructs achieved significantly more lateral bending stability than the other constructs (p < 0.001; C1LM–C2PS average ROM 1.51° [95% CI 1.23°–1.78°]; C1LM–C2TL average ROM −0.07° [95% CI −0.44° to 0.29°]). CONCLUSIONS Meta-analysis of the existing literature showed that all constructs provided significant stabilization in all axes of rotation, except for the C1LM–C2TL construct in lateral bending. There were significant differences in stabilization achieved in each axis of motion by the various screw constructs. These results underline the various strengths and weaknesses in biomechanical stabilization of different screw constructs. There was significant heterogeneity in the data reported across the studies. Standardized spinal motion segment configuration and injury models may provide more consistent and reliable results.

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Section: Discussionmentioning

confidence: 99%

Section: Screw Constructsmentioning

confidence: 99%

Section: Cadaveric Model Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis

Du¹,

Aichmair²,

Kueper³

et al. 2015

SPI

View full text Add to dashboard Cite

show abstract

“…Even though technically more challenged, requiring a CT angiogram study before its use to visualize the vertebral artery course in the C1-2 region, biomechanical studies suggest that this construction provides the highest level of stability in this region 22 .…”

mentioning

confidence: 99%

“…Although we do not use this technique for axis fixation in any case in this series because of surgeon's personal preference (AFJ) in using C1 lateral mass screws, C1-2 transarticular screw fixation to stabilize C1 and C2 is widely used and described in literature 22 . Even though technically more challenged, requiring a CT angiogram study before its use to visualize the vertebral artery course in the C1-2 region, biomechanical studies suggest that this construction provides the highest level of stability in this region 22 .…”

mentioning

confidence: 99%

Axis instrumentation: surgical results

Joaquim

Ghizoni

Anderle³

et al. 2012

Arq. Neuro-Psiquiatr.

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OBJECTIVE: Evaluate the surgical results of axis screw instrumentation. METHODS: Retrospective evaluation of the clinical and radiological data of patients submitted to axis fixation using screws. RESULTS: Seventeen patients were surgically treated. The mean age was 41.8 years (range: 12-73). Spinal cord trauma was the most common cause of instability (8 patients - 47%). Bilateral axis fixation was performed in all cases, except one, with laminar screw (total of 33 axis screws). Seven patients (41.1%) underwent bilateral pars screws; laminar screws were used in six cases and pedicular screws were used in two. In two cases, we performed a hybrid construction (laminar + pars and pedicle + pars). There was no neurological worsening or death, nor complications directly related to use axis screws. CONCLUSION: Axis instrumentation was effective and safe, regardless of the technique used for stabilization. Based on our learnt experience, we proposed an algorithm to choose the best technique for axis screw fixation.

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