Biomechanical comparison of posterior cervical fixation. 2001

H Mihara, and B C Cheng, and S M David, and K Ohnari, and T A Zdeblick
Department of Orthopaedic Surgery, University of Wisconsin Hospital, Madison, USA.

METHODS Biomechanical stability using four different posterior cervical fixation techniques was evaluated in human cadaveric spine. OBJECTIVE To introduce an alternative interspinous fixation technique using wavy-shaped rods, and to compare its in vitro biomechanical stability with that of other posterior cervical fixation techniques. BACKGROUND Fixation of the posterior cervical spine with interspinous wiring is well known as Rogers' or Bohlman's technique. Recently, several plate fixation techniques have been used for posterior cervical stabilization. Since 1983, the authors have developed the wavy-shaped rod system as an alternative to the interspinous fixation technique. This unique technique has been proven clinically useful in Japan. However, the authors are not aware of any prior biomechanical studies. METHODS Seven fresh frozen cervical human spines were tested at the C5-C6 motion segment. Nondestructive static biomechanical testing was performed with flexion-extension, lateral bending, and axial rotation for the following stabilization techniques: intact spine, creation of a Stage 3 distractive-flexion injury followed by fixation with the wavy-shaped rods bounded by three multistrand cables, interspinous wiring with a multistrand cable, triple wiring technique using multistrand cables with a pair of unicortical grafts from the ilium, and lateral mass plate fixation with Magerl's screw technique. Testing was performed on a material testing machine (MTS 858 Bionix test system, MTS, Minneapolis, MN), and load displacement curves were obtained using four linear extensometers and one rotatory extensometer across the C5-C6 motion segment. RESULTS In axial compression loading, the reconstructed specimens showed significant differences in range of motion measured at the anterior and posterior positions, and statistical analysis was performed using one-way analysis of variance. In a comparison of the four fixation techniques, the construct with the wavy-shaped rod indicated significantly less motion both anteriorly and posteriorly than with the other fixation techniques. Also in flexion-extension loading, all the techniques significantly limited the intervertebral motion below the level of the intact motion segment. Particularly, the construct with the wavy-shaped rod showed the smallest mobility, 49.9% anteriorly and 9.3% posteriorly, compared with that of the intact spine. In lateral bending, the lateral mass plate provided the greatest stability, which was superior to the intact segment, but the difference was not statistically significant. In axial rotation, all the reconstruction techniques limited the angular motion below the intact level (wavy rod, 68.0%; Rogers' wiring, 75.2%; Bohlman's triple wiring, 59.8%; lateral mass plate, 71.7%), but no significant differences were observed using one-way analysis of variance, as compared with the intact segment. CONCLUSIONS All four reconstruction techniques restored the stability of the cervical motion segment to at least the level of the intact motion segment before destabilization. An alternative cervical posterior fixation technique, the Wavy Rod system, was considered the most effective technique in stabilizing a cervical motion segment, particularly in axial compression and flexion extension loading.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D008422 Materials Testing The testing of materials and devices, especially those used for PROSTHESES AND IMPLANTS; SUTURES; TISSUE ADHESIVES; etc., for hardness, strength, durability, safety, efficacy, and biocompatibility. Biocompatibility Testing,Biocompatible Materials Testing,Hemocompatibility Testing,Testing, Biocompatible Materials,Testing, Hemocompatible Materials,Hemocompatibility Testings,Hemocompatible Materials Testing,Materials Testing, Biocompatible,Materials Testing, Hemocompatible,Testing, Biocompatibility,Testing, Hemocompatibility,Testing, Materials,Testings, Biocompatibility
D009984 Orthopedic Fixation Devices Devices which are used in the treatment of orthopedic injuries and diseases. Device, Orthopedic Fixation,Devices, Orthopedic Fixation,Fixation Device, Orthopedic,Fixation Devices, Orthopedic,Orthopedic Fixation Device
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D002574 Cervical Vertebrae The first seven VERTEBRAE of the SPINAL COLUMN, which correspond to the VERTEBRAE of the NECK. Cervical Spine,Cervical Spines,Spine, Cervical,Vertebrae, Cervical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D013123 Spinal Fusion Operative immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies with a short bone graft or often with diskectomy or laminectomy. (From Blauvelt & Nelson, A Manual of Orthopaedic Terminology, 5th ed, p236; Dorland, 28th ed) Spondylodesis,Spondylosyndesis,Fusion, Spinal,Fusions, Spinal,Spinal Fusions,Spondylodeses,Spondylosyndeses

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