Comparison of fatigue strength of C2 pedicle screws, C2 pars screws, and a hybrid construct in C1-C2 fixation.

Abstract

A biomechanical study comparing the fatigue strength of different types of C2 fixation in a C1-C2 construct. To determine the pullout strength of a C2 pedicle screw and C2 pars screw after cyclical testing and differentiate differences in stiffness pre- and post-cyclical loading of 3 different C1-C2 fixations. Some surgeons use a short C2 pars screw in a C1-C2 construct, because it is less technically demanding and/or when the vertebral artery is high riding. Difference in construct stiffness between use of bilateral C2 pedicle screws, bilateral C2 pars screws, or a hybrid construct is unknown. Biomechanical testing was performed on 15 specimens. A bicortical C1 lateral mass screw was used in combination with 1 of 3 methods of C2 fixation: (1) bilateral long C2 pedicle screws (LL), (2) bilateral 14-mm C2 pars screws (SS), and (3) unilateral long C2 pedicle screw with a contralateral 14-mm C2 pars screw (LS). Each construct was subject to 16,000 cycles to simulate the immediate postoperative period. Changes in motion in flexion-extension, lateral bending, and axial rotation were calculated. This was followed by pullout testing. The ability to limit range of motion significantly decreased after cyclical testing in flexion-extension, lateral bending, and axial rotation for all 3 groups. After loading, the LL and LS groups had less percentage of increase in motion in flexion-extension and lateral bending than the SS group. Overall, the average pullout strength of a pedicle screw was 92% stronger than a pars screw. C2 pedicle screws have twice the pullout strength of C2 pars screws after cyclical loading. In cases in which the anatomy limits placement of bilateral C2 pedicle screws, a construct using a unilateral C2 pedicle screw with a contralateral short pars screw is a viable option and compares favorably with a bilateral C2 pedicle screw construct. N/A.