Evaluation of an occipito-cervico fusion with a new implant design: a biomechanical study

Abstract

Background A novel implant for occipitocervical fusion consisting of a median plate with an additional hook inserting in the foramen magnum was tested. Aim of this study was to test the stability of a new implant for occipitocervical fusion against the already available and employed median plate implant without hook. Material and method 36 rigid polyurethane foams occipital artificial bones were used. The two occipital implants, namely the occipital plate with hook (Group 1) and the one without hook (Group 2), were applied to the artificial occiput trough three occipital screws and ensured into the experimental setup trough a crossbar. The test parameters were set using the testing machine software as follows: (1) test speed: 10 mm/ min, with 25 mm/ min maximum; (2) preload: 5 N; (3) force switch-off threshold: 90% force drop from F_max. Failure force and path were recorded. Failure force is defined as the maximum reaction force under which failure occurs (F_max), while failure path is the travel path during which failure occurs (dL). Results Group 1 (plate with hook) showed a mean failure force of 459.3 ± 35.9 N and a mean failure path of 5.8 ± 0.3 mm Group 2 (plate without hook) showed a mean failure force of 323.9 ± 20.2 N and a mean failure path of 7.2 ± 0.4 mm. The Shapiro-Wilk test score was not significant (P > 0.1), assuming that data were normally distributed. Group 1 had a statistically significant greater F_max (+ 135.37; P > 0.0001) and less dL (− 1.52; P > 0.0001) compared to group 2. Conclusions Medial plates with foramen magnum hooks showed to be more stable that plates without a hook. These new implants may represent a new tool in OCJ fixation, but further studies are required to investigate their behavior in an anatomical setting.