Biomechanical stability evaluation of the fixation technique for crossed rods consisting of occipital plate and C<sub>2</sub> bilateral lamina screws_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIU Feng ¹ , XU Xilin ¹ ,  MA Xiangyang ² , JIANG Weicheng ¹ , LIU Gengchao ¹ , FANG Zhouqun ¹ , LIN Zejiang ¹

1. Department of Orthopaedics, Puning Overseas Chinese Hospital, Puning Guangdong, 515300, P.R.China;
2. Department of Spinal Surgery, Orthopaedics Hospital, General Hospital of Southern Theatre Command, Guangzhou Guangdong, 510010, P.R.China;

Corresponding author：

MA Xiangyang, Email: maxy1001@126.com

Keywords：

Occipitocervical fixation; crossed rods; biomechanics; atlantoaxial instability

DOI：

10.7507/1002-1892.202005029

Video：

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Objective To evaluate the stability of the fixation technique for the crossed rods consisting of occipital plate and C₂ bilateral lamina screws by biomechanical test.Methods Six fresh cervical specimens were harvested and established an atlantoaxial instability model. The models were fixed with parallel rods and crossed rods after occipital plate and C₂ bilateral laminae screws were implanted. The specimens were tested in the following sequence: atlantoaxial instability model (unstable model group), under parallel rods fixation (parallel fixation group), and under crossed rods fixation (cross fixation group). The range of motion (ROM) of the C_0-2 segments were measured in flexion-extension, left/right lateral bending, and left/right axial rotation. After the test, X-ray film was taken to observe the internal fixator position.Results The biomechanical test results showed that the ROMs in flexion-extension, left/right lateral bending, and left/right axial rotation were significantly lower in the cross fixation group and the parallel fixation group than in the unstable model group (P<0.05). There was no significant difference between the cross fixation group and the parallel fixation group in flexion-extension and left/right lateral bending (P>0.05). In the left/right axial rotation, the ROMs of the cross fixation group were significantly lower than those of the parallel fixation group (P<0.05). After the test, the X-ray film showed the good internal fixator position.Conclusion The axial rotational stability of occipitocervical fusion can be further improved by crossed rods fixation when the occipital plate and C₂ bilateral lamina screws are used.

Citation： QIU Feng, XU Xilin, MA Xiangyang, JIANG Weicheng, LIU Gengchao, FANG Zhouqun, LIN Zejiang. Biomechanical stability evaluation of the fixation technique for crossed rods consisting of occipital plate and C₂ bilateral lamina screws. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1545-1549. doi: 10.7507/1002-1892.202005029 Copy

1.	He X, Meng Y, Zhang J, et al. Bone grafting of atlantoaxial joints and occipitocervical or atlantoaxial fusion for the reduction and fixation of basilar invagination with atlantoaxial dislocation by a posterior approach: a preliminary study. World Neurosurg, 2017, 100: 230-235.
2.	Hale AT, Say I, Shah S, et al. Traumatic occipitocervical distraction injuries in children: a systematic review. Pediatr Neurosurg, 2019, 54(2): 75-84.
3.	Upadhyaya M, Jain S, Kire N, et al. Surgical, clinical, and radiological outcomes of occipitocervical fusion using the plate-screw-rod system with allograft in craniocervical instability. J Craniovertebr Junction Spine, 2019, 10(4): 216-223.
4.	谢天浩, 马生辉, 丁慧超, 等. 齿状突切除术后两种后路内固定方式的生物力学比较. 中国临床神经外科杂志, 2020, 25(7): 447-450.
5.	Finn MA, Fassett DR, Mccall TD, et al. The cervical end of an occipitocervical fusion: a biomechanical evaluation of 3 constructs. Laboratory investigation. J Neurosurg Spine, 2008, 9(3): 296-300.
6.	Lehman RA, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connector for an unstable atlantoaxial joint. Spine J, 2012, 12(2): 151-156.
7.	马向阳, 杨进城, 邱锋, 等. 枕颈交叉棒临床固定技术的建立与临床应用. 中国骨与关节损杂志, 2015, 30(11): 1121-1123.
8.	曹正霖, 罗荣森, 禤天航, 等. 枢椎侧块关节前倾对寰枢椎稳定性的影响及不同重建方式的生物力学评价. 中国脊柱脊髓杂志, 2019, 29(12): 1096-1102.
9.	Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J, 1998, 7(2): 148-154.
10.	Liu S, Song Z, Liu L, et al. Biomechanical evaluation of C1 lateral mass and C2 translaminar bicortical screws in atlantoaxial fixation: an in vitro human cadaveric study. Spine J, 2018, 18(4): 674-681.
11.	Ashafai NS, Visocchi M, Wąsik N. Occipitocervical fusion: an updated review. Acta Neurochir Suppl, 2019, 125: 247-252.
12.	Gu J, Lei W, Xin Z, et al. Occiput-axis crossing translaminar screw fixation technique using offset connectors: an in vitro biomechanical study. Clin Neurol Neurosurg, 2018, 169: 49-54.
13.	Cristante AF, Torelli AG, Kohlmann RB, et al. Feasibility of intralaminar, lateral mass, or pedicle axis vertebra screws in children under 10 years of age: a tomographic study. Neurosurgery, 2012, 70(4): 835-838.
14.	马向阳, 尹庆水, 吴增晖, 等. 枢椎椎板螺钉与椎弓根螺钉抗拔出强度的比较. 中国脊柱脊髓杂志, 2007, 17(2): 137-139.
15.	Gabriel JP, Muzumdar AM, Khalil S, et al. A novel crossed rod configuration incorporating translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study. Spine J, 2011, 11(1): 30-35.
16.	Shen K, Deng Z, Yang J, et al. Biomechanical study of novel unilateral C1 posterior arch screws and C2 laminar screws combined with an ipsilateral crossed C1-C2 pedicle screw-rod fixation for atlantoaxial instability. Arch Orthop Trauma Surg, 2017, 137(10): 1349-1355.

1. He X, Meng Y, Zhang J, et al. Bone grafting of atlantoaxial joints and occipitocervical or atlantoaxial fusion for the reduction and fixation of basilar invagination with atlantoaxial dislocation by a posterior approach: a preliminary study. World Neurosurg, 2017, 100: 230-235.
2. Hale AT, Say I, Shah S, et al. Traumatic occipitocervical distraction injuries in children: a systematic review. Pediatr Neurosurg, 2019, 54(2): 75-84.
3. Upadhyaya M, Jain S, Kire N, et al. Surgical, clinical, and radiological outcomes of occipitocervical fusion using the plate-screw-rod system with allograft in craniocervical instability. J Craniovertebr Junction Spine, 2019, 10(4): 216-223.
4. 谢天浩, 马生辉, 丁慧超, 等. 齿状突切除术后两种后路内固定方式的生物力学比较. 中国临床神经外科杂志, 2020, 25(7): 447-450.
5. Finn MA, Fassett DR, Mccall TD, et al. The cervical end of an occipitocervical fusion: a biomechanical evaluation of 3 constructs. Laboratory investigation. J Neurosurg Spine, 2008, 9(3): 296-300.
6. Lehman RA, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connector for an unstable atlantoaxial joint. Spine J, 2012, 12(2): 151-156.
7. 马向阳, 杨进城, 邱锋, 等. 枕颈交叉棒临床固定技术的建立与临床应用. 中国骨与关节损杂志, 2015, 30(11): 1121-1123.
8. 曹正霖, 罗荣森, 禤天航, 等. 枢椎侧块关节前倾对寰枢椎稳定性的影响及不同重建方式的生物力学评价. 中国脊柱脊髓杂志, 2019, 29(12): 1096-1102.
9. Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J, 1998, 7(2): 148-154.
10. Liu S, Song Z, Liu L, et al. Biomechanical evaluation of C1 lateral mass and C2 translaminar bicortical screws in atlantoaxial fixation: an in vitro human cadaveric study. Spine J, 2018, 18(4): 674-681.
11. Ashafai NS, Visocchi M, Wąsik N. Occipitocervical fusion: an updated review. Acta Neurochir Suppl, 2019, 125: 247-252.
12. Gu J, Lei W, Xin Z, et al. Occiput-axis crossing translaminar screw fixation technique using offset connectors: an in vitro biomechanical study. Clin Neurol Neurosurg, 2018, 169: 49-54.
13. Cristante AF, Torelli AG, Kohlmann RB, et al. Feasibility of intralaminar, lateral mass, or pedicle axis vertebra screws in children under 10 years of age: a tomographic study. Neurosurgery, 2012, 70(4): 835-838.
14. 马向阳, 尹庆水, 吴增晖, 等. 枢椎椎板螺钉与椎弓根螺钉抗拔出强度的比较. 中国脊柱脊髓杂志, 2007, 17(2): 137-139.
15. Gabriel JP, Muzumdar AM, Khalil S, et al. A novel crossed rod configuration incorporating translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study. Spine J, 2011, 11(1): 30-35.
16. Shen K, Deng Z, Yang J, et al. Biomechanical study of novel unilateral C1 posterior arch screws and C2 laminar screws combined with an ipsilateral crossed C1-C2 pedicle screw-rod fixation for atlantoaxial instability. Arch Orthop Trauma Surg, 2017, 137(10): 1349-1355.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical stability evaluation of the fixation technique for crossed rods consisting of occipital plate and C₂ bilateral lamina screws

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Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical stability evaluation of the fixation technique for crossed rods consisting of occipital plate and C2 bilateral lamina screws

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Biomechanical stability evaluation of the fixation technique for crossed rods consisting of occipital plate and C₂ bilateral lamina screws