Biomechanical comparison of anterior cervical plating and combined anterior/lateral mass plating.
BACKGROUND
Previous studies showed anterior plates of older design to be inadequate for stabilizing the cervical spine in all loading directions. No studies have investigated enhancement in stability obtained by combining anterior and posterior plates.


OBJECTIVE
To determine which modes of loading are stabilized by anterior plating after a cervical burst fracture and to determine whether adding posterior plating further significantly stabilizes the construct.


METHODS
A repeated-measures in vitro biomechanical flexibility experiment was performed to investigate how surgical destabilization and subsequent addition of hardware components alter spinal stability.


METHODS
Six human cadaveric specimens were studied.


METHODS
Angular range of motion (ROM) and neutral zone (NZ) were quantified during flexion, extension, lateral bending, and axial rotation.


METHODS
Nonconstraining, nondestructive torques were applied while recording three-dimensional motion optoelectronically. Specimens were tested intact, destabilized by simulated burst fracture with posterior distraction, plated anteriorly with a unicortical locking system, and plated with a combined anterior/posterior construct.


RESULTS
The anterior plate significantly (p<.05) reduced the ROM relative to normal in all modes of loading and significantly reduced the NZ in flexion and extension. Addition of the posterior plates further significantly reduced the ROM in all modes of loading and reduced the NZ in lateral bending.


CONCLUSIONS
Anterior plating systems are capable of substantially stabilizing the cervical spine in all modes of loading after a burst fracture. The combined approach adds significant stability over anterior plating alone in treating this injury but may be unnecessary clinically. Further study is needed to assess the added clinical benefits of the combined approach and associated risks.
Spinal Biomechanics Research Laboratory, Barrow Neurological Institute, 350 W. Thomas Road, Phoenix, AZ 85013, USA.
M S
MS
Adams
N R
NR
Crawford
R H
RH
Chamberlain
Bse
V K
VK
Sonntag
C A
CA
Dickman
D000368:Aged; D001696:Biomechanical Phenomena; D001860:Bone Plates; D002102:Cadaver; D002574:Cervical Vertebrae / Q000601:surgery*; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology*; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000601:surgery; D013314:Stress, Mechanical; D016474:Weight-Bearing