Bone graft translation of four upper cervical spine fixation techniques in a cadaveric model

The goal of spinal fixation is to promote bony fusion by restricting motion at the site of the bone graft. Therefore, in order to evaluate the efficiency of various cervical fixation techniques, we determined the translations at the posterior arch of C1 for four C1-C2 posterior techniques: Gallie, Brooks, Magerl, and Halifax. Our model was the cadaveric specimen, with extensive soft tissue injury: transection of the alar, transverse, and capsular ligaments. Under three-dimensional physiological loading, we recorded the motion of C1 relative to C2, and calculated the translations at the surface of the graft in three dimensions, 10 specimens being tested intact, injured, and instrumented with each of the techniques. We assumed that translational laxity or neutral zone was the critical motion parameter and evaluated it, quantified herein as the neutral zone, at seven points at the graft site. The three-dimensional neutral zone translations were analyzed by their axial and shear components. We found that there was no significant difference with the fixation techniques in the average axial translation (Brooks: 1.1 mm; Magerl: 1.3 mm; Gallie: 1.5 mm; and Halifax: 0.5 mm). In shear, the Magerl averaged 1 mm, which was significantly less than the Gallie (2.1 mm). The Brooks (1.6 mm) and Halifax (1 mm) were not different from each other, Magerl, or Gallie. We propose that evaluation by translational laxity (neutral zone) at the graft site is a noteworthy concept in biomechanical analysis.