Computed Tomography and Biomechanical Comparison between Trans-Articular Screw Fixation and 2 Polymethylmethacrylate Cemented Constructs for Ventral Atlantoaxial Stabilization

Guillaume Leblond; Noël M. M. Moens; Luis Gaitero; Alex zur Linden; Fiona M. K. James; Gabrielle Monteith; Robert J. Runciman

doi:10.1055/s-0038-1661397

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2018; 31(05): 344-355
DOI: 10.1055/s-0038-1661397

Original Research

Georg Thieme Verlag KG Stuttgart · New York

Computed Tomography and Biomechanical Comparison between Trans-Articular Screw Fixation and 2 Polymethylmethacrylate Cemented Constructs for Ventral Atlantoaxial Stabilization

Guillaume Leblond

¹Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada

,

Noël M. M. Moens

¹Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada

,

Luis Gaitero

¹Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada

,

Alex zur Linden

¹Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada

,

Fiona M. K. James

¹Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada

,

Gabrielle Monteith

¹Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada

,

Robert J. Runciman

²School of Engineering, University of Guelph, Guelph, Ontario, Canada

› Author Affiliations

Abstract

Objectives Canine ventral atlantoaxial stabilization methods have been constantly evolving over the past few decades. Yet, proper experimental data comparing the feasibility and biomechanical properties of currently available surgical options are lacking. The aims of this study were (1) to describe and compare the safety profiles and biomechanical properties of three ventral atlantoaxial stabilization methods; and (2) to test whether recently reported optimal implant definitions constitute reasonable guidelines.

Methods Three types of atlantoaxial stabilization including trans-articular screw fixation (TSF) and two cemented constructs (MI5 and MI6) were performed in 21 Beagle cadavers. Post-surgical computed tomography (CT) images of the constructs and biomechanical data were then generated and statistically analysed.

Results The CT data revealed that TSF achieved significantly better apposition than cemented constructs. Out of 91 screws positioned, 4.4% were graded as dangerous and 86.8% as optimal. Optimal positioning was most challenging to obtain for mono-cortical screws. Analysis of biomechanical data suggested that all three techniques could likely achieve similar rates of atlantoaxial fusion when submitted to physiological loads but also that cemented constructs were less prone to failure compared with TSF.

Clinical Significance This study provides evidence that all three techniques are technically feasible and biomechanically viable but also that the evaluated surgical guidelines could be improved.

Keywords

atlantoaxial instability - dogs - computed tomography - biomechanics - spine surgery

Full Text

References

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Supplementary Material