Posterior cervical spine crisscross fixation: Biomechanical evaluation |
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| Institution: | 1. Department of Neurosurgery, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee, WI, United States;2. Joint Department of Biomedical Engineering, Medical College of Wisconsin and Marquette University, Milwaukee, WI, United States;3. University of Cincinnati, Cincinnati, OH, United States;4. Santa Clara Valley Medical Center, San Jose, CA, United States;1. Unidad de Patología de Columna, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain;2. Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria;1. Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, United States of America;2. Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, United States of America;3. VA Medical Center Research – 151, Milwaukee, WI 53295, United States of America;1. Department of Mechanical and Industrial Engineering, Ryerson University, 350 Victoria St, Toronto, ON M5B 2K3, Canada;2. Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada;3. Division of Cardiac Surgery, Sunnybrook Hospital, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada;4. Oakville Trafalgar Memorial Hospital, 3001 Hospital Gate, Oakville, ON L6M 0L8, Canada;5. Faculty of Medicine, Department of Surgery, McMaster University, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada |
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| Abstract: | BackgroundBiomechanical/anatomic limitations may limit the successful implantation, maintenance, and risk acceptance of posterior cervical plate/rod fixation for one stage decompression-fusion. A method of posterior fixation (crisscross) that resolves biomechanical deficiencies of previous facet wiring techniques and not reliant upon screw implantation has been devised. The biomechanical performance of the new method of facet fixation was compared to the traditional lateral mass plate/screw fixation method.MethodsThirteen human cadaver spine segments (C2-T1) were tested under flexion-compression loading and four were evaluated additionally under pure-moment load. Preparations were evaluated in a sequence of surgical alterations with intact, laminectomy, lateral mass plate/screw fixation, and crisscross facet fixation using forces, displacements and kinematics.FindingsCombined loading demonstrated significantly lower bending stiffness (p < 0.05) between laminectomy compared to crisscross and lateral mass plate/screw preparations. Crisscross fixation showed a comparative tendency for increased stiffness. The increased overall motion induced by laminectomy was resolved by both fixation techniques, with crisscross fixation demonstrating a comparatively more uniform change in segmental motions.InterpretationThe crisscross technique of facet fixation offers immediate mechanical stability with resolution of increased flexural rotations induced by multi-level laminectomy. Many of the anatomic limitations and potentially deleterious variables that may be associated with multi-level screw fixation are not associated with facet wire passage, and the subsequent fixation using a pattern of wire connection crossing each facet joint exhibits a comparatively more uniform load distribution. Crisscross wire fixation is a valuable addition to the surgical armamentarium for extensive posterior cervical single-stage decompression-fixation. |
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