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Biomechanical comparison of transpedicular versus intralaminar C2 fixation in C2-C6 subaxial constructs
Michael T Benke1, Joseph R O'Brien, Alexander W L Turner
1Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia, USA.
Study Design:
Biomechanical study.
Objective:
To compare the relative rigidity of C2 transpedicular versus intralaminar fixation with and without offset connectors in C2-C6 subaxial constructs.
Summary Of Background Data:
Insufficient biomechanical data exists on C2 laminar fixation in subaxial constructs, and no study has considered C2-C6 subaxial constructs or the use of offset connectors.
Methods:
Six fresh-frozen cadaveric cervical spines underwent rigidity testing in the intact condition and after a destabilizing C3-C6 laminectomy. Specimens were instrumented with 20 mm pedicle and 20 mm intralaminar screws at C2, and with 14 mm lateral mass screws from C3-C6. In random order, three conditions (C2 pedicle screws, C2 laminar screws, and C2 laminar screws with offset connectors) were tested in flexion-extension, axial rotation, and lateral bending.
Results:
Laminar screws in C2-C6 constructs were equivalent to transpedicular fixation in flexion-extension (P = 0.985), were significantly more rigid than pedicle screws in axial rotation (P = 0.002), and were significantly less rigid than pedicle screws in lateral bending (P = 0.002). Laminar screw constructs were more rigid than the intact condition in all planes.
