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Stabilization of the Atlantoaxial Joint With C1-C3 Lateral Mass Screw Constructs: Biomechanical Comparison With Standard Technique

Brasiliense, Leonardo B C MD1; Lazaro, Bruno C R MD1; Reyes, Phillip M BSE1; Fox, Douglas MD2; Sonntag, Volker K H MD3; Crawford, Neil R PhD1

doi: 10.1227/NEU.0b013e3181fb414c
Operative Technique

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.

1Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

2NeuroTexas Institute, St. David's Medical Center, Austin, Texas

3Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Received, August 3, 2009.

Accepted, June 28, 2010.

Reprint requests: Neil R. Crawford, PhD, c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013. E-mail:

Copyright © by the Congress of Neurological Surgeons