Biomechanical Evaluation of Unilateral Versus Bilateral C1 Lateral Mass-C2 Intralaminar Fixation.

Abstract

Biomechanical, cadaveric study. To compare the relative stiffness of unilateral C1 lateral mass-C2 intralaminar fixation to intact specimens and bilateral C1 lateral mass-C2 intralaminar constructs. The biomechanical integrity of a unilateral C1 lateral mass-C2 intralaminar screw construct was compared to intact specimens and bilateral C1 lateral mass-C2 intralaminar screw constructs. Five human cadaveric specimens were used. Range of motion and stiffness were tested to determine the stiffness of the constructs. Unilateral fixation significantly decreased flexion/extension range of motion compared to intact (<i>P</i> < .001) but did not significantly affect axial rotation (<i>P</i> = .3) or bending range of motion (<i>P</i> = .3). There was a significant decrease in stiffness in extension for both unilateral and bilateral fixation techniques compared to intact (<i>P</i> = .04 and <i>P</i> = .03, respectively). There was also a significant decrease in stiffness for ipsilateral rotation for the unilateral construct compared to intact (<i>P</i> = .007) whereas the bilateral construct significantly increased ipsilateral rotation stiffness compared to both intact and unilateral fixation (<i>P</i> < .001). Bilateral constructs did show improved biomechanical properties compared to the unilateral constructs. However, unilateral C1-C2 fixation using a C1 lateral mass and C2 intralaminar screw-rod construct decreased range of motion and improved stiffness compared to the intact state with the exception of extension and ipsilateral rotation. Hence, a unilateral construct may be acceptable in clinical situations in which bilateral fixation is not possible, but an external orthosis may be necessary to achieve a fusion.