Stabilization of the atlantoaxial joint with C1-C3 lateral mass screw constructs: biomechanical comparison with standard technique

Leonardo B C Brasiliense, Bruno C R Lazaro, Phillip M Reyes, Douglas Fox, Volker K H Sonntag, Neil R Crawford
Neurosurgery 2010, 67 (2 Suppl Operative): 422-8

BACKGROUND: Anatomically and biomechanically, the atlantoaxial joint is unique compared with the remainder of the cervical spine.

OBJECTIVE: To assess the in vitro stability provided by 2 C2 screw sparing techniques in a destabilized model of the atlantoaxial joint and compare with the gold standard system.

METHODS: The 3-dimensional intervertebral motion of 7 human cadaveric cervical spine specimens was recorded stereophotogrammetrically while applying nonconstraining, nondestructive pure moments during flexion-extension, left and right axial rotation, and left and right lateral bending. Each specimen was tested in the intact state, followed by destabilization (odontoidectomy) and fixation as follows: (1) C1 and C3 lateral mass screws rods with sublaminar wiring of C2 (LC1-C3 + SW), (2) C1 and C3 lateral mass screws rods with a cross-link in the C1-2 interlaminar space (LC1-C3 + CL), (3) C1 and C3 lateral mass screw rods alone (negative control), and (4) C1 lateral mass and C2 pedicle screws rods augmented with C1-2 interspinous wire and graft (LC1-PC2, control group).

RESULTS: Compared with the intact spine, each instrumented state significantly stabilized range of motion and lax zone at C1-2 (P < .001, 1-way repeated-measures analysis of variance). LC1-C3 + SW was equivalent to LC1-PC2 during flexion and lateral bending and superior to LC1-C3 + CL during lateral bending, while LC1-C3 + CL was equivalent to LC1-PC2 only during flexion. In all other comparisons, LC1-PC2 was superior to both techniques.

CONCLUSION: From a biomechanical perspective, both C2 screw sparing techniques provided sufficient stability to be regarded as an alternative for C1-2 fixation. However, because normal motion across C2-3 is sacrificed, these constructs should be used in patients with unfavorable anatomy for standard fixations.

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