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Biomechanical analysis comparing three C1-C2 transarticular screw salvaging fixation techniques.

Hossein Elgafy1, Tejaswy Potluri, Vijay K Goel

  • 1Engineering Center for Orthopaedic Research Excellence, Department of Bioengineering, College of Engineering, University of Toledo, Toledo, OH, USA. helgafy@u.washington.edu

Spine
|January 19, 2010
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Summary

C1-C2 transarticular screw fixation with C1 lateral mass and C2 intralaminar screws or C2 pedicle screws offers superior biomechanical stability compared to sublaminar wire fixation for the atlantoaxial complex.

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Spinal Fusion Techniques

Background:

  • Atlantoaxial complex stabilization is complex due to intricate anatomy.
  • C1-C2 transarticular screw fixation is standard but risks vertebral artery injury.
  • Alternative fixation methods are needed when contralateral transarticular screws are contraindicated.

Purpose of the Study:

  • To compare the biomechanical stability of three C1-C2 transarticular screw salvaging techniques.
  • Evaluate fixation methods for the atlantoaxial complex.
  • Determine optimal salvage techniques for C1-C2 fixation.

Main Methods:

  • In vitro biomechanical study using nine human cervical spines (C0-C4).
  • Applied pure moments in six loading directions to intact and instrumented spines.
  • Assessed vertebral motion using a 3D motion measurement system after applying different C1-C2 fixation techniques.

Main Results:

  • All three tested techniques significantly reduced motion compared to the intact spine.
  • Fixation with C1 lateral mass and C2 pedicle screws (TS+C1LMS+C2PS) was equivalent to C1 lateral mass and C2 intralaminar screws (TS+C1LMS+C2ILS).
  • Both TS+C1LMS+C2PS and TS+C1LMS+C2ILS were superior to sublaminar wire (TS+wire) in axial rotation.

Conclusions:

  • C1-C2 fixation using unilateral transarticular screw with contralateral C1 lateral mass and C2 intralaminar screws is biomechanically sound.
  • This technique is equivalent to using C1 lateral mass and C2 pedicle screws.
  • Both methods are superior to C1-C2 sublaminar wire fixation in axial rotation.