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Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

 Soo-Bin Lee  ;  Hwan-Mo Lee  ;  Tae-Hyun Park  ;  Sung Jae Lee  ;  Young-Woo Kwon  ;  Seong-Hwan Moon  ;  Byung Ho Lee 
 APPLIED SCIENCES-BASEL, Vol.10(20) : 7291, 2020-10 
Journal Title
Issue Date
cervical spine surgery ; allograft spacer ; lateral mass ; pedicle screws ; finite element model
Background: There are a few biomechanical studies that describe posterior fixation methods with pedicle screws (PS) and lateral mass screws (LMS); the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown. Methods: Finite element model (FEM) analyses were used to investigate the effects of a hybrid technique using posterior PS and LMS. Stress distribution and subsidence risk from a combination of screws under hybrid motion control conditions, including flexion, extension, axial rotation, and lateral bending, were investigated to evaluate the biomechanical characteristics of different six-screw combinations. Findings: The load sharing on the allograft spacer in flexion mode was highest in the LMS model (74.6%) and lowest in the PS model (35.1%). The likelihood of subsidence of allograft spacer on C6 was highest in the screws from the distal LMS (type 5) model during flexion and extension (4.902 MPa, 30.1% and 2.189 MPa, 13.4%). In lateral bending, the left unilateral LMS (type 4) model screws on C5 (3.726 MPa, 22.9%) and C6 (2.994 MPa, 18.4%) yielded the greatest subsidence risks, because the lateral bending forces were supported by the LMS. In counterclockwise axial rotation, the left unilateral LMS (type 4) model screws on C5 (3.092 MPa, 19.0%) and C6 (3.076 MPa, 18.9%) demonstrated the highest subsidence risks. Conclusion: The asymmetrical ipsilateral use of LMS and posterior PS in lateral bending and axial rotation demonstrated the lowest stability and greatest subsidence risk. We recommend bilateral symmetrical insertion of LMS or posterior PS and posterior PS on distal vertebrae for increased stability and reduced risk of allograft spacer subsidence
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Moon, Seong Hwan(문성환)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
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