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Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw–rod fixation for atlantoaxial instability

  • Lei Shi
  • Kai Shen
  • Rui Deng
  • Zheng-Jian Yan
  • Kai-Lu Liang
  • Liang Chen
  • Zhen-Yong Ke
  • Zhong-Liang Deng
Original Article
  • 102 Downloads

Abstract

Purpose

To investigate the anatomical and biomechanical feasibility of the unilateral C1 double screw [pedicle screw (PS) + lateral mass screw (LMS)] and ipsilateral C2 PS combined with contralateral C2 laminar screw (LS)-rod fixation for atlantoaxial instability by comparison with traditional posterior fixation methods.

Methods

Fifteen sets of complete dry bony specimens of atlas were used for morphometric analysis. The working length, width and thickness of the C1 PSs and LMSs were manually measured. Ten fresh-frozen cervical spines (C0–C7) were used to complete the range of motion (ROM) testing in their intact condition, under destabilization and after stabilization by the following procedures: unilateral C1–C2 PS rod fixation (Group A), bilateral C1–C2 PS rod fixation (Group B), and unilateral C1 double screw and ipsilateral C2 PS combined with contralateral C2 LS rod fixation (Group C).

Results

The working thickness of the C1 PS was ≤ 3.5 mm in only one (1/15 = 6.7%) specimen. The other parameters were > 3.5 mm in all specimens. In the ROM test, all fixation groups showed significantly reduced flexibility in all directions compared with both the intact and destabilization groups. Further, Groups B and C showed better stability in all directions than Group A. However, no significant differences were observed between Groups B and C.

Conclusion

The C1 unilateral lateral mass could mostly contain two screws(PS + LMS) with diameters ≤ 3.5 mm. The novel technique of unilateral C1 double screw and ipsilateral C2 PS combined with contralateral C2 LS rod fixation provided better stability than unilateral PS rod fixation and similar as bilateral PS rod fixation. Therefore, it is a feasible salvage method that provides a new insight into atlantoaxial instability.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Atlantoaxial instability Morphometric analysis Biomechanics C1 double screw Unilateral fixation 

Notes

Funding

The study was supported by the national nature science foundation of China (No. 81301573), natural science foundation of Chongqing (No. cstc2013jcyjA10090), the special foundation for social safeguard and scientific innovation of Chongqing (No. cstc2016shms-ztzx10001-6), Science and technology foundation of Yuzhong district in Chongqing (No. 20160131), Chongqing research and innovation project of graduate students(No.YB17112).

Compliance with ethical standards

Conflict of interest

All authors have declared that they have no conflicts of interest.

Supplementary material

586_2018_5853_MOESM1_ESM.pptx (1.1 mb)
Supplementary material 1 (PPTX 1090 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Lei Shi
    • 1
    • 2
  • Kai Shen
    • 1
    • 3
  • Rui Deng
    • 1
  • Zheng-Jian Yan
    • 1
    • 2
  • Kai-Lu Liang
    • 1
    • 2
  • Liang Chen
    • 1
    • 2
  • Zhen-Yong Ke
    • 1
    • 2
  • Zhong-Liang Deng
    • 1
    • 2
  1. 1.Department of OrthopedicsThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingPeople’s Republic of China
  2. 2.Geriatric Clinical Research Center of ChongqingChongqingPeople’s Republic of China
  3. 3.Department of OrthopedicsChongqing General HospitalChongqingPeople’s Republic of China

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