Study Design. Five different reconstructions of the atlantoaxial complex we
re biomechanically compared in vitro in a nondestructive test.
Objectives. To determine whether non-bone graft-dependent one-point fixatio
n 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 mo
tion around C1-C2. However, placement of transarticular screws is technical
ly demanding. Posterior wiring techniques affording one-point fixation have
failures of similar to 15%, with failure considered to be secondary to str
uctural bone-graft failures. One-point, non-bone graft-dependent fixations
have not been tested.
Methods. Eight human cervical specimens, C0-C3 were loaded: nondestructivel
y, Unconstrained three-dimensional segmental motion was measured. The recon
structions 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 flex
ion-extension, higher stiffness levels were observed in one- and three-poin
t fixations when compared with the intact spine (P < 0.05). In lateral bend
ing no significant differences were observed among the six groups, although
the trend was that reconstructions including transarticular screws provide
d greater stability than one-point fixations.
Conclusion. The current findings substantiate the use of three-point fixati
on as the treatment of choice for C1-C2 instability.