Biomechanical Assessment of Stabilization of Simulated Type II Odontoid Fracture with Case Study
| Autor: | Roy Thomas Daniel, Brandon Bucklen, Lukas Bobinski, Soumya S. Yandamuri, John Michael Duff, Noelle Klocke, Mir Hussain |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Atlantoaxial stabilization lcsh:Medicine Cervical biomechanics Interarticular spacer Odontoid fracture Orthopaedics 03 medical and health sciences 0302 clinical medicine Posterior fixation Type II dens fracture medicine Orthopedics and Sports Medicine Orthodontics 030222 orthopedics business.industry lcsh:R Basic Study Orthopedic surgery Ortopedi Fracture (geology) Surgery Clinical case business 030217 neurology & neurosurgery Biomechanical assessment |
| Zdroj: | Asian Spine Journal Asian Spine Journal, Vol 11, Iss 1, Pp 15-23 (2017) |
| Popis: | Study DesignResearchers created a proper type II dens fracture (DF) and quantified a novel current posterior fixation technique with spacers at C1–C2. A clinical case study supplements this biomechanical analysis.PurposeResearchers explored their hypothesis that spacers combined with posterior instrumentation (PI) reduce range of motion significantly, possibly leading to better fusion outcomes.Overview of LiteratureLiterature shows that the atlantoaxial joint is unique in allowing segmental rotary motion, enabling head turning. With no intervertebral discs at these joints, multiple ligaments bind the axis to the skull base and to the atlas; an intact odontoid (dens) enhances stability. The most common traumatic injury at these strong ligaments is a type II odontoid fracture.MethodsEach of seven specimens (C0–C3) was tested on a custom-built six-degrees-of-freedom spine simulator with constructs of intact state, type II DF, C1–C2 PI, PI with joint capsulotomy (PIJC), PI with spacers (PIS) at C1–C2, and spacers alone (SA). A bending moment of 2.0 Nm (1.5°/sec) was applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). One-way analysis of variance with repeated measures was performed.ResultsDF increased motion to 320%, 429%, and 120% versus intact (FE, LB, and AR, respectively). PI significantly reduced motion to 41%, 21%, and 8%. PIJC showed negligible changes from PI. PIS reduced motion to 16%, 14%, and 3%. SA decreased motion to 64%, 24%, and 54%. Reduced motion facilitated solid fusion in an 89-year-old female patient within 1 year.ConclusionsType II odontoid fractures can lead to acute or chronic instability. Current fixation techniques use C1–C2 PI or an anterior dens screw. Addition of spacers alongside PI led to increased biomechanical rigidity over intact motion and may offer an alternative to established surgical fixation techniques. |
| Databáze: | OpenAIRE |
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