Effects of occipital-atlas stabilization in the upper cervical spine kinematics: an in vitro study

César Hidalgo-García,Miguel Malo-Urriés,Jacobo Rodríguez-Sanz,Albert Pérez-Bellmunt,Ana I Lorente,José Miguel Tricás-Moreno,Carlos López-De-Celis,Mario Maza-Frechín,Orosia Lucha-López,John Krauss

doi:10.1038/s41598-021-90052-6

César Hidalgo-García, Miguel Malo-Urriés + Show 8 more

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https://doi.org/10.1038/s41598-021-90052-6

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Abstract

This study compares upper cervical spine range of motion (ROM) in the three cardinal planes before and after occiput-atlas (C0–C1) stabilization. After the dissection of the superficial structures to the alar ligament and the fixation of C2, ten cryopreserved upper cervical columns were manually mobilized in the three cardinal planes of movement without and with a screw stabilization of C0–C1. Upper cervical ROM and mobilization force were measured using the Vicon motion capture system and a load cell respectively. The ROM without C0–C1 stabilization was 19.8° ± 5.2° in flexion and 14.3° ± 7.7° in extension. With stabilization, the ROM was 11.5° ± 4.3° and 6.6° ± 3.5°, respectively. The ROM without C0–C1 stabilization was 4.7° ± 2.3° in right lateral flexion and 5.6° ± 3.2° in left lateral flexion. With stabilization, the ROM was 2.3° ± 1.4° and 2.3° ± 1.2°, respectively. The ROM without C0–C1 stabilization was 33.9° ± 6.7° in right rotation and 28.0° ± 6.9° in left rotation. With stabilization, the ROM was 28.5° ± 7.0° and 23.7° ± 8.5° respectively. Stabilization of C0–C1 reduced the upper cervical ROM by 46.9% in the sagittal plane, 55.3% in the frontal plane, and 15.6% in the transverse plane. Also, the resistance to movement during upper cervical mobilization increased following C0–C1 stabilization.

Highlights

This study compares upper cervical spine range of motion (ROM) in the three cardinal planes before and after occiput-atlas (C0–C1) stabilization
There were no statistical differences in the maximal forces applied without and with stabilization of C0–C1 in all directions except for extension in which more force was applied with stabilization of C0–C1 (p = 0.03). This is the first biomechanical study that analyzes the role of C0–C1 restriction of movement on upper cervical spine (UCS) kinematics (C0–C1 and C1–C2)
Screw stabilization of C0 achieved a consistent reduction of mobility in C0–C1, especially in the transverse plane

Summary

Introduction

This study compares upper cervical spine range of motion (ROM) in the three cardinal planes before and after occiput-atlas (C0–C1) stabilization. After the dissection of the superficial structures to the alar ligament and the fixation of C2, ten cryopreserved upper cervical columns were manually mobilized in the three cardinal planes of movement without and with a screw stabilization of C0–C1. Chancey et al (2007) described that 41–45% of the upper cervical flexion and 69–71% of the extension occurred in C0–C14, Fujimori et al (2013) concluded that C0–C1 works mainly for flexion-extension[5] and Bogduk and Mercer (2000) stated that C0–C1 facilitates C1–C2 motion and that C1–C2 is moved passively by forces coming from C0–C12. Et al (2012) concluded that any lateral flexion movement of the upper cervical spine (UCS), when C2 is stabilized, is a sign of craniocervical instability[8]. Kang et al (2019) commented that axial ROM at C0–C1 has rarely been examined in cadaver

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