AUTHOR=Lu Yuzhao , Hang Gai , Feng Yu , Chen Bo , Ma Shenghui , Wang Yang , Xie Tianhao 

TITLE=Biomechanical comparison of anterior axis-atlanto-occipital transarticular fixation and anterior atlantoaxial transarticular fixation after odontoidectomy: A finite element analysis

JOURNAL=Frontiers in Bioengineering and Biotechnology

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2023.1067049

DOI=10.3389/fbioe.2023.1067049

ISSN=2296-4185

ABSTRACT=<p><bold>Background:</bold> Anterior axis-atlanto-occipital transarticular fixation (AAOF) and anterior atlanto-axial transarticular fixation (AAF) are two common anterior screw fixation techniques after odontoidectomy, but the biomechanical discrepancies between them remain unknown.</p><p><bold>Objectives:</bold> To investigate the biomechanical properties of craniovertebral junction (CVJ) after odontoidectomy, with AAOF or AAF.</p><p><bold>Methods:</bold> A validated finite element model of the intact occipital-cervical spine (from occiput to T1) was modified to investigate biomechanical changes, resulting from odontoidectomy, odontoidectomy with AAOF, and odontoidectomy with AAF.</p><p><bold>Results:</bold> After odontoidectomy, the range of motion (ROM) at C1-C2 increased in all loading directions, and the ROM at the Occiput-C1 elevated by 66.2%, 57.5%, and 41.7% in extension, lateral bending, and torsion, respectively. For fixation models, the ROM at the C1-C2 junction was observably reduced after odontoidectomy with AAOF and odontoidectomy with AAF. In addition, at the Occiput-C1, the ROM of odontoidectomy with AAOF model was notably lower than the normal model in extension (94.9%), flexion (97.6%), lateral bending (91.8%), and torsion (96.4%). But compared with the normal model, in the odontoidectomy with AAF model, the ROM of the Occiput-C1 increased by 52.2%, −0.1%, 92.1%, and 34.2% in extension, lateral bending, and torsion, respectively. Moreover, there were no distinctive differences in the stress at the screw-bone interface or the C2-C3 intervertebral disc between the two fixation systems.</p><p><bold>Conclusion:</bold> AAOF can maintain CVJ stability at the Occiput-C1 after odontoidectomy, but AAF cannot. Thus, for patients with pre-existing atlanto-occipital joint instability, AAOF is more suitable than AAF in the choice of anterior fixation techniques.</p>