Anterior C2–C3 fixation with screws: proposal of a new technique and comparative mechanical assays

Abstract

The technical difficulties involved in the anterior fixation of the C2-C3 vertebral segment by means of plates and screws, related to retraction of the structures around the vertebral segment, appropriate exposure of the site and positioning of the screws and plate, motivated the development of a new modality of fixation of this segment using only screws. Fixation of the C2-C3 vertebral segment according to the technique proposed requires less exposure of the vertebral segment and does not involve the technical difficulties of standard fixation with plates and screws. In order to study the mechanical properties of this new modality of vertebral fixation, mechanical tests were performed comparing the proposed technique (fixation solely with screws positioned in the craniocaudal direction) and routinely used fixation (H plate and screws). The tests were performed using 80 cervical spine segments from Landrace pigs aged 5 months. The vertebral segments fixed by the two techniques were divided into experimental groups of ten specimens each and submitted to mechanical tests of flexion, extension, lateral bending and rotation in a universal testing machine. The mechanical properties used to compare the results were the load necessary to produce a pre-established deformation and stiffness. No significant differences were observed between the values obtained for the production of the pre-established deformation in the flexion and rotation tests. In the extension and lateral bending tests, the mean values obtained for vertebral segments fixed only with screws were significantly higher. Analysis of stiffness showed no significant difference in the flexion, rotation and lateral bending tests, whereas in the extension tests, the mean values for the group fixed only with screws were significantly higher. The results of the mechanical tests performed showed that fixation of the C2-C3 segment only with screws was not inferior from a mechanical point of view when compared to fixation with H plates of the Orozco type.