Biomechanical study of different fixation methods for posterior atlantoaxial rod constructs

doi:10.13418/j.issn.1001-165x.2025.4.15

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Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (4) : 456-459. DOI: 10.13418/j.issn.1001-165x.2025.4.15

Biomechanical study of different fixation methods for posterior atlantoaxial rod constructs

Chen Qiling ¹, Ouyang Beiping¹*, Luo Chunshan¹, Liang Dongzhu², Lu Tingsheng¹

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Abstract

Objective To explore the biomechanical stability of different rod constructs in posterior atlantoaxial fixation. Methods Six fresh human occipitocervical specimens were divided into the intact group (Group A). An atlantoaxial instability model with type II odontoid fracture was established based on the intact group (Group B). Different fixation methods were used for posterior atlantoaxial (C1) lateral mass and (C2) pedicle screw fixation on the instability model. This included lateral mass and pedicle screw parallel rod fixation (Group C), cross-rod fixation (Group D), lateral mass and lamina parallel rod fixation (Group E), and cross-rod fixation (Group F). Three-dimensional motion analysis was used to measure the range of motion (ROM) of the atlantoaxial specimens in flexion, extension, lateral bending, and rotation states, and the biomechanical characteristics of each group were evaluated by repeated measures analysis of variance. Results ① In all states, the ROM of the intact group and internal fixation group was less than that of the instability group, with statistical significance (P<0.05); ② There was no statistical difference in ROM among the four internal fixation groups in flexion, extension, and lateral bending states (P>0.05); ③ In the rotation direction, the ROM of the parallel rod internal fixation group was less than that of the cross-rod internal fixation group, with significant difference (P<0.05), but the ROM of Group F was equivalent to Group C, with no statistical difference (P>0.05), ROM: Group D<Group F=Group C<Group E<Group A<Group B. Conclusions The rotational stability of the short-segment parallel rod fixation system composed of C1 lateral mass and C2 pedicle screws is slightly insufficient, while cross-rod fixation can better compensate for it.

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Rod screw / / / Posterior approach / / / Atlantoaxial / / / / Biomechanics.

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Chen Qiling, Ouyang Beiping, Luo Chunshan, Liang Dongzhu, Lu Tingsheng. Biomechanical study of different fixation methods for posterior atlantoaxial rod constructs[J]. Chinese Journal of Clinical Anatomy. 2025, 43(4): 456-459 https://doi.org/10.13418/j.issn.1001-165x.2025.4.15

References

[1] Tu CQ, Chen ZD, Yao XT, et al. Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation: A case report[J] .World J Clin Cases, 2023, 11(20): 4944-4955. DOI:10.12998/wjcc.v11.i20.4944.
[2] 欧阳北平,马向阳,罗春山,等. 三维有限元对新型钉尾横连在后路寰枢椎内固定中的力学稳定性评价[J]. 中国临床解剖学杂志, 2023, 41(6):721-727. DOI: 10.13418/j.issn. 1001-165x.2023.6.16.
Ouyang BP, Ma XY, Luo CS, et al. Evaluation of mechanical stability of new horizontal screw-screw crosslink in posterior C1-C2 pedicle screw-rod fixation by three-dimensional finite element[J]. Chinese Journal of Clinical Anatomy, 2023, 41(6):721-727. DOI: 10. 13418/j.issn. 1001-165x.2023.6.16.
[3] Zhang HX, Zhu Y, Shi XQ, et al. Posterior cervical pedicle screw rod short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation [J].Zhongguo Gu Shang, 2023, 36:490-494. DOI:10.12200/j.issn.1003-0034.2023.05.018.
[4] 欧阳北平, 马向阳, 罗春山, 等. 钉尾横连与棒-棒横连在后路寰枢椎固定中的生物力学对比研究[J]. 中国临床解剖学杂志, 2023, 41(5):588-592. DOI:10.13418/j.issn.1001-165 x.2023.5.15.
Ouyang BP, Ma XY, Luo CS, et al.Biomechanical comparison of horizontal screw-screw crosslink and horizontal rod-rod crosslink in C1-C2 pedicle screw-rod fixation[J]. Chinese Journal of Clinical Anatomy, 2023, 41(5):588-592. DOI:10.13418/j.issn.1001-165 x.2023.5.15.
[5] Itoh Y, Kitagawa R, Numazawa S, et al. Atlantoaxial stabilization using C1 lateral mass and C2 pedicle/translaminar screw fixation by intraoperative C1- and C2-direct-captured navigation with preoperative computed tomography images[J].Asian Spine J, 2023, 17(3): 559-566. DOI:10.31616/asj.2022.0182.
[6] Singh DK, Shankar D, Chand VK, et al. C2 superior facetal osteotomy: a novel technique in complex craniovertebral junction surgery for C1 lateral mass screw placement [J]. Asian Spine J, 2023, 17(6): 1125-1131.DOI:10.31616/asj.2023.0216.
[7] Fiorenza V, Ascanio F, Brunasso L, et al. Nuance in craniovertebral junction surgical approach for posterior C1-C2 harms stabilization: "window transposition" of the external vertebral venous plexus for bloodless C1 lateral mass screw insertion: anatomical aspects and technical notes [J]. Acta Neurochir Suppl, 2023, 135: 307-313. DOI:10.1007/978-3-031-36084-8_47.
[8] 马仁财, 马向阳, 邹小宝, 等. 新型枢椎棘突椎板螺钉固定的影像解剖学测量研究[J]. 中国临床解剖学杂志, 2024, 42(3):251-258. DOI:10.13418/j.issn.1001-165x.2024.3.03.
Ma RC, Ma XY, Zou XB, et al. Imaging anatomical measurement study on the fixation of the novel C2 spinous lamina screw[J]. Chinese Journal of Clinical Anatomy, 2024, 42(3):251-258. DOI:10.13418/j.issn.1001-165x.2024.3.03.
[9] Ebraheim N, Rollins JR Jr, Xu R, et al. Anatomic consideration of C2 pedicle screw placement [J]. Spine, 1996, 21 (6):691-695. DOI:10.1097/00007632-199603150-00005.
[10]Bhatia N, Rama A, Sievers B, et al. Biomechanical evaluation of unilateral versus bilateral C1 lateral mass-C2 intralaminar fixation[J] .Global Spine J, 2017, 7(3): 239-245. DOI:10.1177/2192568217694152.
[11]Ouyang B, Zou X, Luo C, et al. Biomechanical study of horizontal screw-screw crosslink in C1-2 pedicle screw-rod fixation[J]. Clin Spine Surg, 2023,36(10): E519-E523. DOI：10.1097/BSD.0000000000 001515.
[12]Ouyang B, Zou X, Luo C, et al. Finite element analysis of horizontal screw-screw crosslink used in C1-C2 pedicle screw-rod fixation[J]. Med Sci Monit, 2021, 27: e932026. DOI：10.12659/MSM.932026.
[13]Lenz M, Egenolf P, Weber M, et al. Pedicle or lateral mass screws in Goel-Harms construct? A biomechanical analysis [J]. Injury, 2023, S0020-1383(23)00291-7. DOI：10.1016/j.injury.2023.03.035.
[14] Harman F, Oglin V,Yilmaz MO, et al. Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection [J]. J Craniovertebr Junction Spine, 2023, 14(4): 341-345. DOI:10.4103/jcvjs.jcvjs_73_23.
[15]Zheng G, Yuan B, Zhao Y, et al. C1 transposterior arch lateral mass screws combined with C2 pedicle screw and rod fixation for pediatric atlantoaxial subluxation: A minimal 10-year follow-up outcome analysis[J]. Oper Neurosurg (Hagerstown), 2024, 26(3): 286-292. DOI：10.1227/ons.0000000000000963.
[16]Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connector for an unstable atlantoaxial joint [J]. Spine J, 2012, 12(2): 151-156. DOI：10.1016/j.spinee.2012.01.020.
[17]Gorek J, Acaroglu E,Berven S, et al. Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation[J]. Spine (Phila Pa 1976), 2005, 30(13): 1513-1518. DOI:10.1097/01.brs.0000167827.84020.49.
[18]Bhatia N, Rama A, Sievers B, et al. Biomechanical evaluation of unilateral versus bilateral C1 lateral mass-C2 intralaminar fixation[J].Global Spine J, 2017, 7(3): 239-245.DOI:10.1177/2192568217694152.
[19]Shen K, Deng Z, Yang J, et al. Biomechanical study of novel unilateral C1 posterior arch screws and C2 laminar screws combined with an ipsilateral crossed C1-C2 pedicle screw-rod fixation for atlantoaxial instability[J]. Arch Orthop Trauma Surg, 2017, 137(10): 1349-1355. DOI：10.1007/s00402-017-2781-0.
[20] 邱锋, 许喜林, 马向阳, 等. C2椎板螺钉短节段钉棒固定系统中交叉棒与平行棒固定的生物力学比较[J]. 中国组织工程研究, 2021, 25(12):1805-1809.
Qiu F, Xu XL, Ma XY, et al. Biomechanical comparison of atlantoaxial crossed rod and parallel rod fixation technique for C2 unilateral lamina screws[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12):1805-1809.
[21]王大天, 邱锋. 寰枢椎后路钉棒系统交叉棒固定及平行棒固定的生物力学稳定性[J]. 中国组织工程研究, 2022, 26(18): 2801-2806.
Wang DT, Qiu F. Biomechanical stability of crossed-rod fixation and parallel-rod fixation of atlantoaxial posterior screw rod system[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(18):2801-2806.
[22]Qiu F, Zou XB, Xu XL, et al. A biomechanical comparison of crossed and parallel rod configurations in atlantoaxial internal fixation[J].Eur Spine J, 2021, 30(2): 576-584. DOI：10.1007/s00586-020-06655-6.