title: Comparative in vitro biomechanical analysis of a novel posterior cervical fixation technique versus conventional posterior-based constructs.
abstract: METHODS
  Comparative in vitro, cadaveric biomechanical study.
  
  
  OBJECTIVE
  To compare the kinematic response of a new posterior cervical midline surgical technique versus that of conventional fixation techniques.
  
  
  BACKGROUND
  A new method was designed using alternating bilateral intralaminar screws connected with a single midline rod. This technique provides the theoretical benefits of less operative dissection and reduced implant cost, but the acute flexibility properties remain unknown. Using an in vitro cadaveric model, the study objective was to define the operative level(s) changes in multidirectional flexibility after posterior destabilization/reconstruction from C3 to C6.
  
  
  METHODS
  A 6 degree of freedom spine stimulator was used to test flexibility in 7 human cadaveric specimens. Flexion-extension, lateral bending, and axial rotation were tested in the intact condition, followed by destabilization by a simulated posterior column injury from C3 to C6. Specimens were then reconstructed from C3 to C6 and tested in the following sequence: sublaminar hook rod (SH), lateral mass screw rod (LMR), midline laminectomy from C3 to C6 with LMR (MLR), and midline posterior fixation from C3 to C6 (SMF). Range of motion (ROM) and neutral zone were quantified and analyzed.
  
  
  RESULTS
  Significant increases in ROM and neutral zone at C3 to C6 were found under all loading conditions for the destabilized condition and intact spine versus all other treatments (P<0.05). The conventional treatments: SH, LMR, and MLR resulted in significantly less ROM than the proposed SMF in flexion-extension and lateral bending (P<0.05). Axial rotation provided similar results; however, no differences were observed between the SH and SMF (P>0.05). Notably, LMR and MLR provided significantly more stability than SH in axial rotation (P<0.05).
  
  
  CONCLUSIONS
  Data produced suggest that the new, midline rod fixation approach provides less biomechanical stability than conventional posterior cervical reconstruction techniques. In addition, the high incidence of laminar fracture during screw placement and close proximity of the screw trajectory and polyaxial heads to the dura suggest a practical limitation as well.
authors.affiliation: *Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore †The Orthopaedic Spinal Research Laboratory, St Joseph Medical Center, Towson, MD ‡DePuy Spine, A Johnson & Johnson Company, Raynham, MA §Bioengineering Department, University of Toledo, Toledo, OH.
authors.forename: Camilo
authors.initials: C
authors.lastname: Molina
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Kretzer
authors.forename: Nianbin
authors.initials: N
authors.lastname: Hu
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Umekoji
authors.forename: Bryan W
authors.initials: BW
authors.lastname: Cunningham
authors.forename: Hassan
authors.initials: H
authors.lastname: Serhan
mesh_terms: D001696:Biomechanical Phenomena; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D009984:Orthopedic Fixation Devices; D018583:Pliability; D016059:Range of Motion, Articular / Q000502:physiology