Stabilization of the Craniovertebral Junction with Clivus Plate Constructs: Biomechanical Comparison with Conventional Technique

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• 作者：Wei Ji¹ ; Jie Tong² ; Zhiping Huang¹ ; Minghui Zheng¹ ; Xiuhua Wu¹ ; Jianting Chen¹ ; Qingan Zhu¹ ; ^{qinganzhu@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Biomechanics ; Clivus ; Craniovertebral junction ; Mesh cage ; Vertebrae body reconstruction
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：42-49
• 全文大小：1865 K

文摘

Ventral defect caused by resection of the lesions involving the upper cervical spine commonly has been reconstructed with a fabricated mesh cage. Recently, a clival screw and plate fitted to the osseous anatomy of the craniovertebral junction was developed for this pathologic status.

Objective

To evaluate the stability a clivus plate system fixation (CPSF) for the craniovertebral junction and compare it with a conventional fashioned mesh cage fixation (FMCF).

Methods

Seven human fresh cadaveric specimens (occiput [Oc], atlas [C1], axis [C2], third cervical vertebra [C3], fourth cervical vertebra [C4]) were tested with intact and destabilization-reconstruction conditions. FMCF and CPSF were applied randomly to the clivus to the C3 segment combined with posterior occipitocervical fixation applied from the occiput to C4 segment, respectively. Specimens were subjected to a pure moment of 1.5 Nm in flexion, extension, lateral bending, and axial rotation, respectively. The range of motion (ROM) and neutral zone (NZ) from the occiput to C3 were calculated and compared between two anterior fixations.

Results

Motions were reduced significantly in all directions following FMCF and CPSF fixations when compared with the intact. The CPSF resulted in smaller ROM in lateral bending (0.3° vs. 0.6°, P = 0.015), axial rotation (0.6° vs. 1.2°, P = 0.023) and flexion (0.1° vs. 0.3°, P = 0.019), but similar ROM in extension (0.2° vs. 0.4°, P = 0.273) when compared with the FMCF. NZs with the CPSF were 0.1° in flexion-extension, 0.1° in lateral bending and 0.2° in axial rotation, respectively, and similar to NZs with the FMCF.

Conclusions

The clivus plate system fixation is biomechanically superior to the conventional fashioned mesh cage fixation in flexion, lateral bending and axial rotation, but equavalent in extension.