title: Anterior occiput to axis screw fixation: part II: a biomechanical comparison with posterior fixation techniques.
abstract: METHODS
  This biomechanical study used flexibility testing on fresh-frozen human cadaveric specimens (occiput to C3) and compared the range of motion and neutral zone for three occipitocervical fixation techniques.
  
  
  OBJECTIVE
  To contrast the stabilization provided by a new technique of anterior occipitocervical screw fixation with two other commonly used posterior occipitocervical fixation techniques.
  
  
  BACKGROUND
  There are no published reports describing this novel technique of anterior occipitocervical screw fixation.
  
  
  METHODS
  Six human occipitocervical spine specimens were mounted in a custom-designed, spine-testing machine that applied a pure moment in flexion-extension, lateral bending, and axial rotation. The specimens were tested intact, after an odontoid osteotomy with capsular injury, and after each of three fixation methods: posterior wiring, posterior plate fixation with C1-C2 transarticular screws, and finally with anterior occipitocervical screws. Intervertebral motion was measured with an optoelectronic measurement system, and the range of motion and neutral zone were the kinematic variables measured and used for analysis.
  
  
  RESULTS
  In flexion and extension testing, the posterior plate with transarticular screws provided greater stabilization than posterior wiring or anterior occipitocervical screws. In lateral bending and rotation, the anterior screws were similarly effective to the posterior plate, both of which were more effective than posterior wiring.
  
  
  CONCLUSIONS
  The anterior screw fixation technique was as effective as a posterior plate with transarticular screws in stabilizing between the occiput and C2 in axial rotation and lateral bending. In extension and flexion, the anterior screw technique was not as effective as a posterior plate with transarticular screws in providing stability.
authors.affiliation: Division of Spine, Department of Orthopaedics, University of British Columbia and the Combined Neurosurgical and Orthopaedic Spine Program, Vancouver Hospital and Health Sciences Centre, Canada. mdvorak@vanhosp.bc.ca
authors.forename: Marcel F S
authors.initials: MF
authors.lastname: Dvorak
authors.forename: Floyd
authors.initials: F
authors.lastname: Sekeramayi
authors.forename: Qingan
authors.initials: Q
authors.lastname: Zhu
authors.forename: Joel
authors.initials: J
authors.lastname: Hoekema
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.forename: Mike
authors.initials: M
authors.lastname: Boyd
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Goertzen
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Oxland
mesh_terms: D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D006801:Humans; D016268:Internal Fixators; D008422:Materials Testing; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D018583:Pliability; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016474:Weight-Bearing / Q000502:physiology