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Journal of Long-Term Effects of Medical Implants

Published 4 issues per year

ISSN Print: 1050-6934

ISSN Online: 1940-4379

SJR: 0.184 SNIP: 0.485 CiteScore™:: 1.1 H-Index: 39

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A Biomechanical Study of Unilateral Posterior Atlantoaxial Transarticular Screw Fixation

Volume 15, Issue 1, 2005, pp. 33-38
DOI: 10.1615/JLongTermEffMedImplants.v15.i1.40
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ABSTRACT

The purpose of this study was to investigate the fixation of C1−C2 instability with the use of a unilateral screw. Transarticular screw placement across C1−C2 may be contra-indicated in up to 20% of specimens on at least one side because of anatomic variations or other pathological processes. Hence the current study looks into unilateral screw fixation of C1−C2 instability. Eight cervical spine specimens, C1 through C5, were harvested from fresh human cadavers (4 male and 4 female) of average age 67 years (54−80). C1 and C2−C5 vertebrae were potted to allow motion only at the C1−C2 articulation. Cutting the transverse ligament on both sides of the odontoid and the tectorial membrane destabilized the specimens. Transarticular screw fixation of C1−C2 was performed in a manner similar to the technique described by Magerl. The stability was tested after fixation with one transarticular screw together with a posterior graft and wire. Placement of the screw was randomized, resulting in half the specimens receiving screws on the right side and the remaining half on the left side. The stiffness of the C1−C2 articulation was tested in rotation, lateral bending, flexion, and anterior translation in random order. The rotational stiffness was 1.44 ± 0.44 N-m/deg, while lateral bending stiffness values were 2.33 ± 1.14 N-m/mm (right bending) and 2.81 ± 1.36 N-m/mm (left bending). The stiffness value in flexion was 0.813 ± 0.189 N-m/mm and in translation 67.1 ± 25.1 N/m. It was found that stability after unilateral transarticular screw fixation was less than that previously reported after bilateral transarticular screw fixation, but similar to that found with modified Brooks posterior wiring, which has been shown to provide better stability than other posterior wiring methods, and fusion rates of 96% have been reported.
We concluded that C1−C2 unilateral posterior transarticular screw fixation with supplemental posterior graft and wiring would confer adequate stability in cases where bilateral screw placement is contraindicated.

CITED BY
  1. Matsubara Takeshi, Mizutani Jun, Fukuoka Muneyoshi, Hatoh Tsunetoshi, Kojima Hiroshi, Otsuka Takanobu, Safe Atlantoaxial Fixation Using a Laminar Screw (Intralaminar Screw) in a Patient With Unilateral Occlusion of Vertebral Artery, Spine, 32, 1, 2007. Crossref

  2. Hue Yun Hee, Chun Hyoung-Joon, Yi Hyeong-Joong, Oh Seong Hoon, Oh Suck Jun, Ko Yong, Unilateral Posterior Atlantoaxial Transarticular Screw Fixation in Patients with Atlantoaxial Instability : Comparison with Bilateral Method, Journal of Korean Neurosurgical Society, 45, 3, 2009. Crossref

  3. Brockmeyer Douglas L., Lateral mass screw fixation of C-1, Journal of Neurosurgery: Pediatrics, 107, 2, 2007. Crossref

  4. Anderson Richard C. E., Ragel Brian T., Mocco J, Bohman Leif-Erik, Brockmeyer Douglas L., Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients, Journal of Neurosurgery: Pediatrics, 107, 1, 2007. Crossref

  5. Guo Qunfeng, Liu Jun, Ni Bin, Lu Xuhua, Zhou Fengjin, C2 laminar screw and C1-2 transarticular screw combined with C1 laminar hooks for atlantoaxial instability with unilateral vertebral artery injury, Archives of Orthopaedic and Trauma Surgery, 131, 9, 2011. Crossref

  6. Wright Neill M., Translaminar rigid screw fixation of the axis, Journal of Neurosurgery: Spine, 3, 5, 2005. Crossref

  7. Claybrooks Roderick, Kayanja Mark, Milks Ryan, Benzel Edward, Atlantoaxial fusion: a biomechanical analysis of two C1–C2 fusion techniques, The Spine Journal, 7, 6, 2007. Crossref

  8. Mazur Marcus D., Ravindra Vijay M., Brockmeyer Douglas L., Unilateral fixation for treatment of occipitocervical instability in children with congenital vertebral anomalies of the craniocervical junction, Neurosurgical Focus, 38, 4, 2015. Crossref

  9. TAKAYASU Masakazu, AOYAMA Masahiro, JOKO Masahiro, TAKEUCHI Mikinobu, Surgical Intervention for Instability of the Craniovertebral Junction, Neurologia medico-chirurgica, 56, 8, 2016. Crossref

  10. Bhatia Nitin, Rama Asheen, Sievers Brandon, Quigley Ryan, McGarry Michelle H., Lee Yu-Po, Lee Thay Q, Biomechanical Evaluation of Unilateral Versus Bilateral C1 Lateral Mass-C2 Intralaminar Fixation, Global Spine Journal, 7, 3, 2017. Crossref

  11. Liu Shichang, Song Zongrang, Liu Limin, Yin Xinhua, Hu Xiongke, Yang Ming, Wu Qining, Song Yueming, Hao Dingjun, Biomechanical evaluation of C1 lateral mass and C2 translaminar bicortical screws in atlantoaxial fixation: an in vitro human cadaveric study, The Spine Journal, 18, 4, 2018. Crossref

  12. Rocha Rogério, Sawa Anna G.U., Baek Seungwon, Safavi-Abbasi Sam, Hattendorf Fadimatou, Sonntag Volker K.H., Crawford Neil R., ATLANTOAXIAL ROTATORY SUBLUXATION WITH LIGAMENTOUS DISRUPTION, Operative Neurosurgery, 64, 3, 2009. Crossref

  13. Horn Eric M., Hott Jonathan S., Porter Randall W., Theodore Nicholas, Papadopoulos Stephen M., Sonntag Volker K. H., Atlantoaxial stabilization with the use of C1–3 lateral mass screw fixation, Journal of Neurosurgery: Spine, 5, 2, 2006. Crossref

  14. Chittiboina Prashant, Wylen Esther, Ogden Alan, Mukherjee Debi P., Vannemreddy Prasad, Nanda Anil, Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques, Journal of Neurosurgery: Spine, 11, 4, 2009. Crossref

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