Biomechanical effects of transoral odontoidectomy

The acute biomechanical effects of transoral odontoidectomy were studied by using qualitative and quantitative methods to assess atlantoaxial motion. In vitro biomechanical testing was performed on the upper cervical spines of eight baboon and five human cadaveric specimens. Using an unconstrained testing apparatus, we performed a flexibility method of testing. Physiological range loading was applied to atlantoaxial specimens, and three-dimensional motion was analyzed with stereophotogrammetry. Force-deformation relationships were delineated in intact specimens and again after surgical removal of the anterior C1 arch, odontoid process, and transverse atlantal ligament. We studied the total range of rotational and linear motions, the behavior of the neutral zone and elastic zone, the flexibility coefficients, and the instantaneous axes of rotation during flexion, extension, bilateral lateral bending, and bilateral axial rotation. Odontoidectomy produced several distinct alterations in motion and in force-deformation responses at C1-C2 that were almost identical in the baboon and human specimens. After odontoidectomy, the atlas developed significantly increased translational movements, which were most prominent in the anteroposterior direction. The total angular range of motion increased significantly during flexion, extension, and lateral bending but not during axial rotation. When the total range of motion was altered, the neutral zone was affected selectively and the elastic zone was spared. Surgery produced mobile, widely spread, unconstrained instantaneous axes of rotation that were in a constrained, fixed position in intact specimens. Clinically, transoral odontoidectomy may predispose patients to spinal instability. Even if acute spinal instability is not apparent, the patients may be susceptible to the delayed effects of the surgery because of the altered anatomy and biomechanical responses.