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  4. Biomechanical advantage of C1 pedicle screws over C1 lateral mass screws : a cadaveric study
 
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Biomechanical advantage of C1 pedicle screws over C1 lateral mass screws : a cadaveric study

Publikationstyp
Journal Article
Date Issued
2013-12-31
Sprache
English
Author(s)
Fensky, Florian  
Kueny, Rebecca A.  
Sellenschloh, Kay  
Püschel, Klaus  
Morlock, Michael M.  
Rueger, Johannes M.  
Lehmann, Wolfgang  
Huber, Gerd  
Hansen-Algenstaedt, Nils  
Institut
Biomechanik M-3  
TORE-URI
http://hdl.handle.net/11420/9988
Journal
European spine journal  
Volume
23
Issue
4
Start Page
724
End Page
731
Citation
European Spine Journal 23 (4): 724-731 (2014)
Publisher DOI
10.1007/s00586-013-3143-4
Scopus ID
2-s2.0-84897441087
PubMed ID
24378628
Publisher
Springer
Purpose: The established technique for posterior C1 screw placement is via the lateral mass. Use of C1 monocortical pedicle screws is an emerging technique which utilizes the bone of the posterior arch while avoiding the paravertebral venous plexus and the C2 nerve root. This study compared the relative biomechanical fixation strengths of C1 pedicle screws with C1 lateral mass screws. Methods: Nine human C1 vertebrae were instrumented with one lateral mass screw and one pedicle screw. The specimens were subjected to sinusoidal, cyclic (0.5 Hz) fatigue loading. Peak compressive and tensile forces started from ±25 N and constantly increased by 0.05 N every cycle. Testing was stopped at 5 mm displacement. Cycles to failure, displacement, and initial and end stiffness were measured. Finally, CT scans were taken and the removal torque measured. Results: The pedicle screw technique consistently and significantly outperformed the lateral mass technique in cycles to failure (1,083 ± 166 vs. 689 ± 240 cycles), initial stiffness (24.6 ± 3.9 vs. 19.9 ± 3.2 N/mm), end stiffness (16.6 ± 2.7 vs. 11.6 ± 3.6 N/mm) and removal torque (0.70 ± 0.78 vs. 0.13 ± 0.09 N m). Only 33 % of pedicle screws were loose after testing compared to 100 % of lateral mass screws. Conclusions: C1 pedicle screws were able to withstand higher toggle forces than lateral mass screws while maintaining a higher stiffness throughout and after testing. From a biomechanical point of view, the clinical use of pedicle screws in C1 is a promising alternative to lateral mass screws. © 2013 Springer-Verlag.
Subjects
Atlas
Biomechanical fixation strength
Lateral mass screw
Pedicle screw
Stiffness
DDC Class
610: Medizin
Funding(s)
Marie Curie ITN project SpineFX  
Funding Organisations
Freie und Hansestadt Hamburg (FHH)  
More Funding Information
Funding from the State of Hamburg and the Marie Curie ITN project SpineFX is kindly acknowledged.
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