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Comparative In Vitro Biomechanical Analysis of a Novel Posterior Cervical Fixation Technique Versus Conventional Posterior-based Constructs

Molina, Camilo BA*; Kretzer, Ryan M. MD*,†; Hu, Nianbin MD; Umekoji, Hidemasa MD; Cunningham, Bryan W. MS; Serhan, Hassan PhD‡,§

doi: 10.1097/BSD.0b013e31824e1f86
Original Articles

Study Design: Comparative in vitro, cadaveric biomechanical study.

Objective: To compare the kinematic response of a new posterior cervical midline surgical technique versus that of conventional fixation techniques.

Summary of Background Data: A new method was designed using alternating bilateral intralaminar screws connected with a single midline rod. This technique provides the theoretical benefits of less operative dissection and reduced implant cost, but the acute flexibility properties remain unknown. Using an in vitro cadaveric model, the study objective was to define the operative level(s) changes in multidirectional flexibility after posterior destabilization/reconstruction from C3 to C6.

Methods: A 6 degree of freedom spine stimulator was used to test flexibility in 7 human cadaveric specimens. Flexion-extension, lateral bending, and axial rotation were tested in the intact condition, followed by destabilization by a simulated posterior column injury from C3 to C6. Specimens were then reconstructed from C3 to C6 and tested in the following sequence: sublaminar hook rod (SH), lateral mass screw rod (LMR), midline laminectomy from C3 to C6 with LMR (MLR), and midline posterior fixation from C3 to C6 (SMF). Range of motion (ROM) and neutral zone were quantified and analyzed.

Results: Significant increases in ROM and neutral zone at C3 to C6 were found under all loading conditions for the destabilized condition and intact spine versus all other treatments (P<0.05). The conventional treatments: SH, LMR, and MLR resulted in significantly less ROM than the proposed SMF in flexion-extension and lateral bending (P<0.05). Axial rotation provided similar results; however, no differences were observed between the SH and SMF (P>0.05). Notably, LMR and MLR provided significantly more stability than SH in axial rotation (P<0.05).

Conclusions: Data produced suggest that the new, midline rod fixation approach provides less biomechanical stability than conventional posterior cervical reconstruction techniques. In addition, the high incidence of laminar fracture during screw placement and close proximity of the screw trajectory and polyaxial heads to the dura suggest a practical limitation as well.

*Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore

The Orthopaedic Spinal Research Laboratory, St Joseph Medical Center, Towson, MD

DePuy Spine, A Johnson & Johnson Company, Raynham, MA

§Bioengineering Department, University of Toledo, Toledo, OH

Supported by DePuy Spine Inc., Raynham, MA.

The authors declare no conflict of interest.

Reprints: Hassan Serhan, PhD, DePuy Spine, A Johnson & Johnson Company, Raynham, MA 02767 (e-mail:

Received May 31, 2011

Accepted December 8, 2011

© 2014 by Lippincott Williams & Wilkins, Inc.