Biomechanical and morphometric evaluation of occipital condyle for occipitocervical segmental fixation.

Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. Thirteen recently frozen cadaveric specimens were used. The occipital condyle anatomy and the hypoglossal canal dimension were measured using reconstructed computed tomography images. Insertion torque and pullout strength were evaluated to compare the midline occipital keel screw, C0-C1 transarticular screw, C1 lateral mass screw, and direct occipital condyle screw. The dimensions of the occipital condyle allow use of a 3.5 or 4.0-mm diameter screw. Mean pullout strength was 1619.6 N for the midline occipital keel screw, 870.7 N for the C0-C1 transarticular screw, 707.0 N for the C1 lateral mass screw, and 431.7 N for the direct occipital condyle screw. Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients.

Spinal kinematics and facet load transmission after total disc replacement.

STUDY DESIGN: In vitro human cadaveric biomechanical study. OBJECTIVE: The objectives were to determine the effect of total disc replacement (TDR) on kinematics, especially range of motion (ROM), helical axis of motion (HAM), and facet joint contact force. SUMMARY OF BACKGROUND DATA: Ball-and-socket type artificial discs are designed to mimic normal motion, but the biomechanical effect on kinematics has not been thoroughly clarified. METHODS: Fourteen human cadaveric L4-L5 units were tested before and after TDR. In 7 specimens, facet contact forces were directly measured with thin-film piezoresistive load transducers inserted in the facet joints. In the other 7 specimens, the facet joint capsules were kept intact. Moments (±7.5 Nm) were applied in flexion/extension, lateral bending, and axial rotation motion, with and without an axial compressive preload of 400 N. Three-dimensional motion was recorded, and each angular ROM and HAM were calculated. RESULTS: Without axial compressive preload, the TDR did not produce significant differences in ROMs in all cases. However, under compressive preload, the TDR produced significantly larger ROMs for flexion (4.0° and 8.7°) and lateral bending (2.4° and 5.6°) (intact state and TDR, respectively). The TDR did not alter the HAM significantly except the location in lateral bending without compressive preload and the orientation in flexion/extension against horizontal plane. The location of HAM was slightly shifted caudally by the compressive preload in intact and TDR states. Despite the increased ROMs, the facet contact forces were not significantly altered by the TDR either with or without compressive preload (26 N and 27 N in extension, 41 N and 41 N in lateral bending, 117 N and 126 N in axial rotation). CONCLUSION: TDR using a ball-and-socket type artificial disc significantly increased ROM under axial load and maintained the HAM with similar facet contact forces to the intact state.

In vivo three-dimensional morphometric analysis of the lumbar pedicle isthmus.

STUDY DESIGN: In vivo noninvasive study. OBJECTIVE: To properly quantify pedicle anatomic parameters, using subject-based CT three-dimensional models and compare the data from 2-dimensional transverse-CT images. SUMMARY OF BACKGROUND DATA: Accurate measurement of morphometric parameters of pedicle isthmus is important for transpedicular procedures. Anatomically, the lumbar pedicle is known to be elliptical cross-sectionally and slightly inclined in the vertical plane in the lower lumbar levels. Therefore, measurement of the pedicle isthmus may be overestimated when transverse images are used. More accurate measurement of the 3-dimensional geometry of the pedicle is therefore needed. To the best of our knowledge, 3-dimensional geometry of the pedicle has not been reported as the literature values are based on 2-dimensional image data. METHODS: In vivo measurements of the lumbar pedicle isthmus were performed on the 3-dimensional subject-based CT models, using custom-developed software in 89 volunteers. RESULTS: The least axis of pedicle, the longest axis of pedicle and the transverse plane width were largest at L5 in both genders. The isthmus angle declined in the lower levels. The ratio of the transverse plane width to the least axis of pedicle was largest at L5. CONCLUSION: Our results showed that the least axis of pedicle, the longest axis of pedicle and the transverse plane width peaked at L5, and the transverse plane width became approximately twice as long in the lower levels compared to the upper levels. The ratio of the transverse plane width to the least axis of pedicle increased by about 40% at L5. These findings highlight the fact that measuring the isthmus width from CT transverse images leads to overestimation, especially in the lower lumbar spine. Therefore, a 3-dimensional inclination of the least axis of the pedicle should be taken into account for the determination of the pedicle diameter in the lower lumbar vertebrae.