BIOMECHANICAL ANALYSIS OF CERVICAL STABILIZATION SYSTEMS - AN ASSESSMENT OF TRANSPEDICULAR SCREW FIXATION IN THE CERVICAL-SPINE

被引：251

作者：

KOTANI, Y

CUNNINGHAM, BW

ABUMI, K

MCAFEE, PC

机构：

[1] Orthopaedic Biomechanics Laboratory, The Union Memorial Hospital, Baltimore, MD

[2] Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Scoliosis and Spine Center, Sapporo

来源：

SPINE | 1994年 / 19卷 / 22期

关键词：

CERVICAL SPINE; SPINAL INSTRUMENTATION; BIOMECHANICS;

D O I：

10.1097/00007632-199411001-00007

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. The biomechanical stability of seven cervical reconstruction methods including the transpedicular screw fixation was evaluated under four instability patterns. These four modalities, based on the range and grade of instability, allowed a reproducible biomechanical assessment to establish the in vitro role of internal fixation in the cervical spine. Objectives. This study biomechanically investigated the stability of seven reconstruction methods in the cervical spine as influenced by four instability patterns and assessed whether three-column fixation for the cervical spine using transpedicular screw fixation would provide increased stability over that of conventional cervical fixation systems. Methods. A total of 24 calf cervical spine specimens were divided into four experimental groups. The spinal constructs including seven reconstruction techniques-the posterior AO titanium reconstruction plate, Bohlman's posterior triple-wiring, transpedicular screw fixation, anterior iliac bone graft, anterior AcroMed plate, anterior AO titanium locking plate, and combined fixation with the AO anterior plate and posterior triple-wiring-were tested under four loading modes. Results. Anterior plating methods provided less stability than that of posterior constructs under axial, torsional, and flexural loading conditions. Exclusive posterior procedures provided increased stability compared with the intact spine in one level fixation, however, did not sustain the torsional stability when the anterior and middle column was eliminated in two-level fixation. The stabilizing capabilities of both the combined fixation and transpedicular screw fixation were clearly demonstrated in all loading modes, however, those of the latter were superior in multilevel fixation. Conclusion. Front and back approaches, employing the anterior plate and posterior triple-wiring, and transpedicular screw fixation demonstrated clear biomechanical advantages when the extent of instability increased to three-column or multilevel. Three-column fixation for the cervical spine using transpedicular screw fixation offers increased stability over that of conventional cervical fixation systems, particularly in multiple level constructs.

引用

页码：2529 / 2539

页数：11

共 33 条

[21]

Panjabi M.M., Duranceau J., Goel V., Oxland T., Takata K., Cervical human vertebrae: Quantitative three-dimensional anatomy of the middle and lower regions, Spine, 16, pp. 861-869, (1991)

[22]

Ripa D.R., Kowall M.G., Meyer P.R., Rusin J.J., Series of ninety-two traumatic cervical spine injuries stabilized with anterior ASIF plate fusion technique, Spine, 16, (1991)

[23]

Robinson R.A., Walker A.E., Ferlic D.C., Wiecking D.K., The results of anterior interbody fusion of the cervical spine, J Bone Joint Surg, 44A, pp. 1569-1586, (1962)

[24]

Rogers W.A., Fractures and dislocations of the cervical spine, J Bone Joint Surg, 39A, pp. 341-376

[25]

Rogers W.A., Fractures and dislocations of the cervical spine, J Bone Joint Surg, 39A, pp. 341-376

[26]

Roy-Camille R., Saillant G., Laville C., Benazet J.P., Treatment of lower cervical spinal injuries-C3 to C7, Spine, 17, (1992)

[27]

Roy-Camille R., Saillant G., Mazel C., Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws, The Cervical Spine, pp. 390-403, (1989)

[28]

Shirado O., Zdeblick T.A., McAfee P.C., Warden K.E., Biomechanical evaluation of methods of posterior stabilization of the spine and posterior lumbar interbody arthrodesis for lumbosacral isthmic spodylolisthesis: A calf-spine model, J Bone Joint Surg, 73A, pp. 518-526, (1991)

[29]

Smith M.D., Erson P., Grady M.S., Occipitocervical arthrodesis using contoured plate fixation: An early report on a versatile fixation technique, Spine, 18, pp. 1984-1990, (1993)

[30]

Stauffer E.S., Kelly EG. Fracture-dislocations of the cervical spine. Instability and recurrent deformity following treatment by anterior interbody fusion, J Bone Joint Surg, 59A, pp. 45-48, (1977)

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