In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation

Chandan Reddy; Aditya V Ingalhalikar; Scott Channon; Tae-Hong Lim; James Torner; Patrick W Hitchon

doi:10.3171/SPI-07/10/414

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In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation

Journal article

Peer reviewed

In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation

Chandan Reddy, Aditya V Ingalhalikar, Scott Channon, Tae-Hong Lim, James Torner and Patrick W Hitchon

Journal of neurosurgery. Spine, Vol.7(4), pp.414-418

10/2007

DOI: 10.3171/SPI-07/10/414

PMID: 17933316

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Abstract

In instrumentation of the upper cervical spine, placement of pedicle screws into C-2 is generally safe, although there is the potential for injury to the vertebral arteries. Owing to this risk, translaminar screws into C-2 have been used. The aim of this study was to compare the stability of the in vitro cadaveric spine using C-2 laminar compared with C-2 pedicle screws in C2-3 instrumentation. Eight fresh frozen human cadaveric cervical spines (C1-6) were potted at C1-2 and C5-6. Pure moments in increments of 0.3 Nm to a maximum of 1.5 Nm were applied in flexion, extension, right and left lateral bending, and right and left axial rotation. Each specimen was tested sequentially in three modes: 1) intact; 2) C2 pedicle screw-C3 lateral mass fixation; and 3) C2 laminar screw-C3 lateral mass fixation. The sequence of fixation testing was randomized. Motion was tracked with reflective markers attached to C-2 and C-3. Spinal levels with instrumentation showed significantly less motion than the intact spine in all directions and with all loads greater than 0.3 Nm (p < 0.05). Although there was no significant difference between C2 pedicle screw-C3 lateral mass fixation and C2 laminar screw-C3 lateral mass fixation, generally the former type of fixation was associated with less motion than the latter. When pedicle screws in C-2 are contraindicated or inappropriate, laminar screws in C-2 offer a safe and acceptable option for posterior instrumentation.

Bone Screws

Humans

Middle Aged

Male

Atlanto-Axial Joint - surgery

Equipment Design

Spinal Fusion - instrumentation

Weight-Bearing - physiology

Cervical Vertebrae - surgery

Atlanto-Axial Joint - physiopathology

Range of Motion, Articular - physiology

Aged, 80 and over

Female

Aged

Cadaver

Details

Title: Subtitle: In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation
Creators: Chandan Reddy - Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
Aditya V Ingalhalikar
Scott Channon
Tae-Hong Lim
James Torner
Patrick W Hitchon
Resource Type: Journal article
Publication Details: Journal of neurosurgery. Spine, Vol.7(4), pp.414-418
DOI: 10.3171/SPI-07/10/414
PMID: 17933316
NLM abbreviation: J Neurosurg Spine
ISSN: 1547-5654
eISSN: 1547-5646
Publisher: American Association of Neurological Surgeons; United States
Language: English
Date published: 10/2007
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
Record Identifier: 9983995178902771

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