Should we recommend occipital plate fixation using bicortical screws or inverted occipital hooks to optimize occipito-cervical junction fusion? A biomechanical study combining an experimental and analytical approach.

Germaneau, Arnaud; Vendeuvre, Tanguy; Delmotte, Alexandre; d’Houtaud, S.; Brèque, Cyril; Petureau, Louis; Doumalin, Pascal; Dupré, Jean-Christophe; Brémand, Fabrice; Maxy, P.; Richer, Jean‐Pierre; Rigoard, Philippe

doi:10.1016/j.clinbiomech.2020.105173

Cited by 1 publication

(4 citation statements)

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“…Another limitation of the hook implant is the lack of personalization. It is known that a mismatch between hook and bone thickness can limit the stability of the implant [ 8 ]. Due to the inadequate anatomical adaptation of the hook to the bone structure can slip off from the foramen magnum and lead to a loss of the observed biomechanical advantages.…”

Section: Discussionmentioning

confidence: 99%

“…Concentrating on the occipital part of the implants, instrumentation of this area represents a challenge for the surgeon due to its anatomical peculiarities [ 4 , 5 , 6 ]. The occipital protuberance is its thickest bony part, but the thickness is not uniform and gradually decreases laterally and caudally [ 7 ], so that in some settings even the shortest provided screws may be too long or the length of the screw would not provide sufficient stability [ 8 ]. Many occipital implants have been proposed, but no consensus has yet been reached [ 4 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The occipital protuberance is its thickest bony part, but the thickness is not uniform and gradually decreases laterally and caudally [ 7 ], so that in some settings even the shortest provided screws may be too long or the length of the screw would not provide sufficient stability [ 8 ]. Many occipital implants have been proposed, but no consensus has yet been reached [ 4 , 8 ]. Techniques that have been employed include the use of rods attached to wires and onlay bone grafting with wire fixation.…”

Section: Introductionmentioning

confidence: 99%

“…Most screw/plate constructs allow a degree of rotation of the screw head in respect to the plate, which over time can lead to reduction of the implant stability and, eventually, pullout [ 4 ]. For this reason, and also to reduce iatrogenic complications such as lesion of the meningeal sheets or the venous plexus alternative implants such as occipital-condyle screw plates or bone hooks have been developed [ 8 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Migliorini

Baroncini

Mansy

et al. 2021

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%