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Craniocervical fixation with occipital condyle screws: biomechanical analysis of a novel technique
Juan S Uribe1, Edwin Ramos, A Samy Youssef
1Department of Neurosurgery, University of South Florida, Tampa, FL, USA. juansuribe@gmail.com
Study Design:
A human cadaveric biomechanical study comparing craniocervical fixation techniques.
Objective:
To quantitatively compare the biomechanical stability of a new technique for occipitocervical fixation using the occipital condyles with an established method for craniocervical spine fusion.
Summary Of Background Data:
Stabilization of the occipitocervical junction remains a challenge. The occiput does not easily accommodate instrumentation because of access and spatial constraints. In fact, the area available for the implant fixation is limited and can be restricted further when a suboccipital craniectomy has been performed, posing a challenge to current fixation techniques. Occipital screws are also associated with the potential for intracranial complications.
Methods:
Six fresh frozen cadaveric specimens occiput-C4 were tested intact, after destabilization and after fixation as follows: (1) occipital plate with C1 lateral mass screws and C2 pars screws and (2) occipital condyle screws with C1 lateral mass screws and C2 pars screws. Specimens were loaded in a custom spine testing apparatus and subjected to the following tests, all performed under 50-N unconstrained axial preload: flexion, extension, lateral bending, and axial rotation at 1.5 Nm. The constructs were statistically compared with a one-way analysis of variance and compared with the intact condition.
Results:
Motions were reduced by approximately 80% compared with the intact condition for both configurations under all motions. There were no statistically significant differences in the range of motion (ROM) between the 2 instrumentation conditions. The mean values indicated decreased ROM with the novel occipital condyle screw construct in comparison with the standard occipital plate and rod system.
Conclusion:
Craniocervical stabilization using occipital condyle screws as the sole cephalad fixation point is biomechanically equivalent with regard to the modes tested (ROM and stiffness) to the standard occipital plate construct.
