Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation

Abstract

Objective: To compare the biomechanical stability imparted to the C1 and C2 vertebrae by either transarticular screw fixation (TSF) or screw and rod fixation (SRF) techniques in a cadaver model.

Methods: Ten fresh ligamentous human cervical spine specimens were harvested from cadavers. The specimens were tested sequentially in the intact state, after injury and stabilization (unilateral left side and bilateral), and after fatiguing to 5000 cycles (0.5 Hz) at +/-1.0 N.m of flexion and extension. The specimens were stabilized by use of TSF in 5 spines or SRF in the other 5 spines. The data were converted to angular displacements, and the stabilized cases were compared with intact states for evaluating the efficacies of the two techniques in stabilizing the C1-C2 segments.

Results: In the TSF group, the unilateral fixation using one screw imparted a significant stability in only the axial rotation mode. The unilateral procedure in the SRF group was effective in stabilization in all modes except in extension. The bilateral procedure in both of the groups was effective across the C1-C2 segment. However, the SRF group afforded higher stability than the corresponding TSF group in the flexion and extension modes. The degree of stability did not change after fatigue compared with the prefatigue data.

Conclusion: In general, a surgeon should undertake a bilateral fixation to achieve sufficient stability across the atlantoaxial complex, and either technique will provide satisfactory results, although the SRF technique may be better in the flexion and extension modes. One should use the SRF procedure while trying to achieve stability with a unilateral system.