Biomechanical Assessment of Bilateral C1 Laminar Hook and C1-2 Transarticular Screws and Bone Graft for Atlantoaxial Instability

作者：Xiang Guo, Bin Ni, Weidong Zhao, Mingfei Wang, Fengjin Zhou, Songkai Li, Zhong-wu Ren · 发表于：Journal of Spinal Disorders & Techniques · 年份：2009 · DOI：10.1097/bsd.0b013e31818da3fe · 被引用次数：35 · 研究领域：Spinal Fractures and Fixation Techniques、Cervical and Thoracic Myelopathy、Spinal Cord Injury Research

UNLABELLED: STUDYDESIGN: In vitro biomechanical test was conducted to compare the stability of 5 different atlantoaxial posterior fusion techniques. OBJECTIVE: To evaluate the biomechanical stability of an atlas laminar hook combined with transarticular (TA) screws relative to 4 different conventional fusion techniques. SUMMARY OF BACKGROUND DATA: The atlantoaxial instability caused by fractures, rheumatoid arthritis, congenital deformity, or traumatic lesions of the transverse ligament often result in acute or chronic spinal cord compression, a possible threat to a patient's life. Posterior atlantoaxial fixations are used to reconstruct the stability of atlantoaxial articulation. Conventional posterior atlantoaxial fixations are associated with high rates of pseudoarthrosis and carry the potential risk of neurologic complication. TA screw fixation can provide an excellent biomechanical stability. As a modified 3-point fixation technique, the bilateral C1-2 TA screws have been combined with C1 laminar hook and bone grafts. This modified technique had carried good clinical outcomes. METHODS: Eight human specimens (C0-C4) were loaded nondestructively with pure moments and the range of motion at the level of C1-C2 was measured. Eight specimens were implanted with each of the following techniques, respectively: Gallie fixation, C1-2 TA screw fixation combined with Gallie fixation, C1-2 TA screw fixation, C1 laminar hook combined with C1-2 TA screw fixation plus bone grafts, and t...