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KMID : 1145220230200030940
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Neurospine
2023 Volume.20 No. 3 p.940 ~ p.946
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Anterior Transarticular Crossing Screw Fixation for Atlantoaxial Joint Instability: A Biomechanical Study
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Hang Xiao
Zhiping Huang
Panjie Xu
Junyu Lin
Qingan Zhu
Wei Ji
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Abstract
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Objective : To evaluate the biomechanical stability of anterior transarticular crossing screw (ATCS) and compare it with anterior transarticular screw (ATS) which may provide basic evidence for clinical application.
Methods : Eight human fresh cadaveric specimens (occiput-C4) were tested with 5 conditions including the intact status, the injury status (type II odontoid fracture), the injury+ATS fixation status (traditional bilateral ATS fixation); the injury+unilateral ATCS fixation status; and the injury+bilateral ATCS fixation status. Specimens were applied to a pure moment of 1.5 Nm in flexion-extension, lateral bending, and axial rotation, respectively. The range of motions (ROMs) and the neutral zones (NZs) of C1 to C2 segment were calculated and compared between 5 status.
Results : ATS and ATCS fixations significantly reduced the motions in all directions when compared with the intact and injury statues (p < 0.05). In flexion-extension, the ROMs of ATS, unilateral ATCS, and bilateral ATCS were 4.7° ±2.5°, 4.1° ±1.9°, and 3.2° ±1.2°, respectively. Bilateral ATCS resulted in a significant decrease in ROM in flexion-extension when compared with ATS and unilateral ATCS (p = 0.035 and p = 0.023). In lateral bending and axial rotation, there was no significant difference in ROM between the 3 fixations (p > 0.05). Three fixations resulted in similar NZs in all directions (p > 0.05).
Conclusion : ATCS is a biomechanically effective alternative or supplemental method for atlantoaxial instability.
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KEYWORD
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Cervical spine, Atlantoaxial joint, Joint instability, Biomechanics, Cadaver, Internal fixators
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