Skip Navigation LinksHome > December 2010 - Volume 67 - Issue > Stabilization of the Atlantoaxial Joint With C1-C3 Lateral M...
Neurosurgery:
doi: 10.1227/NEU.0b013e3181fb414c
Operative Technique

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

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Abstract

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.

Copyright © by the Congress of Neurological Surgeons

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