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Biomechanical Evaluation of Anterior Plate Fixation With Cage for Basilar Invagination With Atlantoaxial Dislocation: A Cadaveric Study
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DOI：10.14245/ns.2550694.347.png)
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Abstract
En 中文
Objective: To evaluate the biomechanical characteristics of 2 anterior fixation techniques occipitocervical fixation (POCF) for basilar invagination with atlantoaxial dislocation (BIAAD), under varying atlantoaxial lateral mass cage heights (4-10 mm). Methods: Seven fresh cadaveric specimens (occiput to C3, Oc-C3) were tested in the following conditions: (1) intact state; (2) BI-AAD state; (3) BI-AAD+CPF; (4) BI-AAD+TARP fixation; (5) BI-AAD+POCF. A pure 1.5 Nm moment loads to specimens in flexion/extension, lateral bending and axial rotation. Range of motion (ROM) and neutral zone (NZ) values at Oc-C2 were calculated and compared. Results: ROM of the C1-2 segment under the intact and BI-AAD states were as follows: 9.3 degrees +/- 4.6 degrees versus 21.3 degrees +/- 8.3 degrees in flexion, 4.6 degrees +/- 1.9 degrees versus 9.3 degrees +/- 3.8 degrees in extension, 3.6 degrees +/- 2.2 degrees versus 12.0 degrees +/- 6.5 degrees in lateral bending, and 68.9 degrees +/- 14.4 degrees versus 76.6 degrees +/- 6.6 degrees in axial rotation, respectively. Compared with BI-AAD states, all internal fixation techniques significantly reduced the ROM of the Oc-C2 segment. TARP fixation exhibited larger ROM in flexion-extension. While in lateral bending and axial rotation, the ROM values for the anterior plate constructs were smaller than that of POCF, with a statistically significant difference observed between CPF and POCF. Cage height variations showed no significant impact on overall biomechanical stability. Conclusion: Anterior plate fixation techniques demonstrated superior resistance to lateral bending and rotational forces compared to posterior approaches, with clival plate fixation exhibiting optimal biomechanical stability for BI-AAD. Variations in cage height exhibited negligible impact on stability when internal fixation achieved adequate rigidity.
Keywords:
Basilar invagination
Atlantoaxial dislocation
Internal fixation
Biomechanics
Fusion cage
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