Biomechanics of occipitocervical fixation.
METHODS
A human cadaveric biomechanical study comparing occipital fixation techniques.


OBJECTIVE
To compare ranges of motion between midline and lateral occipital fixation and between rigid and nonrigid occipital fixation of an unstable craniocervical spine.


BACKGROUND
New fixation techniques using rods and screws increase surgical choice on where fixation is placed onto the occiput. Lateral fixation theoretically gives improved resistance to deformation because of its increased effective moment arm and bilateral purchase. Midline fixation allows significantly longer screw purchase. This study compares these two fixation location.


METHODS
Cadaveric occipital cervical spine specimens were tested biomechanically intact and under six different fixation techniques. Range of motion between the skull and C2 at 1.5 N-m and 2 N-m bending moments was measured in flexion-extension, lateral bending, and axial rotation. Mechanical testing of different rod diameters and a reconstruction plate was performed and compared with biomechanical testing. Results were compared between the intact condition and all fixations, between the medial and lateral fixations, and between the rigid and nonrigid fixations by analysis of variance.


RESULTS
The range of motion of all constructs was significantly reduced compared with intact. Significant differences between groups were only seen in lateral bending in fixation placed laterally. Mechanical testing demonstrated that construct stiffness was predicted by area moment of inertia of the rod and plate to a greater degree than variation in placement of occipital screws or locking of the implant.


CONCLUSIONS
The choice of location of occipital fixation should be based more on the ease of use and instability pattern. The decreased stiffness of the newer small rod systems should be considered.
Department of Orthopedic Surgery, University of Wisconsin, Madison 53972, USA. anderson@surgery.wisc.edu
Paul A
PA
Anderson
Ashish L
AL
Oza
Thomas J
TJ
Puschak
Rick
R
Sasso
D001696:Biomechanical Phenomena / Q000295:instrumentation / Q000379:methods; D002574:Cervical Vertebrae / Q000502:physiology* / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D009777:Occipital Bone / Q000502:physiology* / Q000601:surgery; D018583:Pliability; D016059:Range of Motion, Articular / Q000502:physiology