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Biomechanical and Clinical Aspects on Fixation Techniques in the Cervical Spine
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The present work is analyzing the general biomechanical aspects of fixation techniques in the upper and lower cervical spine along with clinical implications.

The in vitro biomechanical properties of five different posterior atlanto-axial fixation techniques are compared. They provided for either a one, two or three-point fixation between atlas and axes. A new device, the C1 claw was biomechanically tested, which allow for fixation without the need for a structural bone graft. The three-point reconstructions indicated superior biomechanical properties compared to all others.

The new C1 claw device was clinically evaluated in a series of 26 patients treated with a posterior C1-C2 fusion. There were no clinical or radiological failures in the series, Twenty-one patients out of twenty-three with any length of follow up either showed a solidly healed fusion or a healed fracture.

Distractive flexion (DF) injuries in the lower cervical spine treated with anterior plate alone were analyzed with respect to healing rate and complications in a consecutive series of 36 patients. Results indicated that DF injury stage 1 and 2 according to Allen and Ferguson healed without complication, whereas DF injuries stage 3 had a high frequency of failure, needing an additional posterior fixation.

The in vitro biomechanical properties of four different fixation techniques for a distractive flexion injury stage 3 were analyzed. The result indicated that anterior plate alone for fixation of a DF injury stage 3 is insufficient supporting the clinical finding in the previous study.

Adjacent level motion was analyzed following a one segment fusion in the lower cervical spine. Motion was found to increase in adjacent levels possibly contributing to accelerated degeneration.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2003. , p. 37
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1286
Keywords [en]
Medicine, Biomechanics, Atlanto-axial fusion, Distractive flexion injuries, cervical spine, adjacent level motion
Keywords [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:uu:diva-3574ISBN: 91-554-5735-5 (print)OAI: oai:DiVA.org:uu-3574DiVA, id: diva2:163316
Public defence
2003-10-17, Rosénsalen, ingång 95/96, Uppsala, 09:15
Opponent
Supervisors
Available from: 2003-09-11 Created: 2003-09-11Bibliographically approved
List of papers
1. Biomechanical comparison of five different atlantoaxial posterior fixation techhniques
Open this publication in new window or tab >>Biomechanical comparison of five different atlantoaxial posterior fixation techhniques
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2000 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, no 22, p. 2877-2883Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN:

Five different reconstructions of the atlantoaxial complex were biomechanically compared in vitro in a nondestructive test.

OBJECTIVES:

To determine whether non-bone graft-dependent one-point fixation affords stability levels equivalent to three-point reconstructions.

SUMMARY OF BACKGROUND DATA:

Previous investigations have demonstrated that three-point fixation, using bilateral transarticular screws in combination with posterior wiring, provide the most effective resistance to minimize motion around C1-C2. However, placement of transarticular screws is technically demanding. Posterior wiring techniques affording one-point fixation have failure rates of approximately 15%, with failure considered to be secondary to structural bone graft failures. One-point, non-bone graft-dependent fixations have not been tested.

METHODS:

Eight human cervical specimens, C0-C3 were loaded nondestructively. Unconstrained three-dimensional segmental motion was measured. The reconstructions tested were two one-point fixations, one two-point fixation, and two three-point fixations.

RESULTS:

Under axial rotation two and three-point reconstructions provided better stiffness than the one-point reconstructions (P < 0.05). During flexion-extension, higher stiffness levels were observed in one- and three-point fixations when compared with the intact spine (P < 0.05). In lateral bending no significant differences were observed among the six groups, although the trend was that reconstructions including transarticular screws provided greater stability than one-point fixations.

CONCLUSION:

The current findings substantiate the use of three-point fixation as the treatment of choice for C1-C2 instability. [l: atlantoaxial fixation, biomechanics, cervical spine, instability, spinal instrumentation, transarticular screws]

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90827 (URN)11074673 (PubMedID)
Available from: 2003-09-11 Created: 2003-09-11 Last updated: 2017-12-14Bibliographically approved
2. Posterior atlanto-axial fusion with the Olerud cervical fixation system for odontoid fractures and C1-C2 instability in reumathoid arthritis
Open this publication in new window or tab >>Posterior atlanto-axial fusion with the Olerud cervical fixation system for odontoid fractures and C1-C2 instability in reumathoid arthritis
2003 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 12, no 1, p. 91-96Article in journal (Refereed) Published
Abstract [en]

In posterior C1-C2 fusion, traditional wire fixation gives poor stability. The bone quality is often insufficient to provide the competent structural bone graft that is required, and the introduction of sublaminar wires is somewhat dangerous. The stability is markedly improved by adding transarticular screws, but the drawbacks of structural bone graft and sublaminar wires remain. The C1 claw of the Olerud Cervical Fixation System improves C1-C2 fixation without relying on structural bone graft or compromising the spinal canal. The aim of this study was to evaluate radiological healing and possible complications in a consecutive series of C1-C2 fusions from our department operated with the C1 claw device. Twenty-six patients (14 women) with a mean age of 73 (range 37-93) years were included. The diagnoses were odontoid fracture in 18 patients, rheumatoid instability in 6, and odontoid non-union and os odontoideum in 1 each. The patients were followed clinically and with plain radiographs for an average of 15 (range 3-27) months. There were no neurological or vascular complications, and no secondary displacements or reoperations in the series. Twenty patients followed for 6-27 months were radiographically healed. Six patients died from unrelated causes 1-38 months postoperatively. Three of these patients had no radiographs later than the postoperative control, one had a healed odontoid fracture but resorbed bone graft at 8 months, while the remaining two patients were not healed, but showed no signs of healing disturbance at the time of death. On the basis of the findings of this study, posterior C1-C2 fusion with the Olerud Cervical Fixation System seems promising. No serious complications related to the surgical procedure were encountered. The stability of the implant obviates the use of a solid bone block as a graft and still allows a high frequency of fusion healing.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90828 (URN)10.1007/s00586-002-0470-2 (DOI)12592552 (PubMedID)
Available from: 2003-09-11 Created: 2003-09-11 Last updated: 2017-12-14Bibliographically approved
3. Distractive flexion injuries of the subaxial cervical spine treated with anterior plate alone
Open this publication in new window or tab >>Distractive flexion injuries of the subaxial cervical spine treated with anterior plate alone
2004 (English)In: Journal of Spinal Disorders & Techniques, ISSN 1536-0652, E-ISSN 1539-2465, Vol. 17, no 1, p. 1-7Article in journal (Refereed) Published
Abstract [en]

The clinical and radiographic effect of anterior plate fixation alone was evaluated in 36 consecutive patients with distractive flexion (DF) injuries in the lower cervical spine. Mean follow-up time was 15 months. The aim of the present study was to determine whether anterior plate fixation alone provides sufficient stability when treating DF injuries in the cervical spine. Solid union was seen in 6 of 6 patients with stage 1 injury and in 15 of 17 patients with stage 2 injury. In the patients with stage 3 injury, 7 of 13 of the anterior fixations failed. These failures occurred mainly among the patients with severe neurologic injuries. We believe these findings substantiate the use of anterior plate alone for DF injuries at stage 1 and 2 but disqualify anterior plate fixation alone for DF injuries at stage 3, with neurologic injury present.

Keywords
Adolescent, Adult, Aged, Bone Plates/standards/*statistics & numerical data, Cervical Vertebrae/*injuries/pathology/radiography, Female, Follow-Up Studies, Humans, Internal Fixators/standards/*statistics & numerical data, Laryngeal Nerves/injuries/physiopathology, Magnetic Resonance Imaging, Male, Middle Aged, Neurosurgical Procedures/*instrumentation/methods, Postoperative Complications/etiology/pathology/physiopathology, Spinal Cord Injuries/pathology/radiography/surgery, Spinal Fusion/*instrumentation/methods, Spinal Injuries/pathology/radiography/*surgery, Traction, Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90829 (URN)14734968 (PubMedID)
Available from: 2003-09-11 Created: 2003-09-11 Last updated: 2017-12-14Bibliographically approved
4. Biomechanical evaluation of four different fixation techniques for a distractive flexion injury stage 3 of the cervical spine An in vitro human cadaveric model
Open this publication in new window or tab >>Biomechanical evaluation of four different fixation techniques for a distractive flexion injury stage 3 of the cervical spine An in vitro human cadaveric model
Show others...
In: SpineArticle in journal (Refereed) In press
Identifiers
urn:nbn:se:uu:diva-90830 (URN)
Available from: 2003-09-11 Created: 2003-09-11Bibliographically approved
5. Adjacent level motion, a human cadaveric study of the cervical spine before and after one segment fixation
Open this publication in new window or tab >>Adjacent level motion, a human cadaveric study of the cervical spine before and after one segment fixation
In: SpineArticle in journal (Refereed) In press
Identifiers
urn:nbn:se:uu:diva-90831 (URN)
Available from: 2003-09-11 Created: 2003-09-11Bibliographically approved

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