Biomechanics of Halo-Vest and Dens Screw Fixation for Type II Odontoid Fracture
An in vitro biomechanical study of halo-vest and odontoid screw fixation of Type II dens fracture. The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2009-03, Vol.34 (5), p.484-490 |
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| creator | IVANCIC, Paul C BEAUCHMAN, Naseem N MO, Fred LAWRENCE, Brandon D |
| description | An in vitro biomechanical study of halo-vest and odontoid screw fixation of Type II dens fracture.
The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined.
Previous studies have evaluated posterior fixation techniques for stabilizing dens fracture. No previous biomechanical study has investigated the halo-vest and odontoid screw for stabilizing dens fracture.
A biofidelic skull-neck-thorax model was used with 5 osteoligamentous whole cervical spine specimens. Three-dimensional flexibility tests were performed on the specimens while intact, following simulated dens fracture, and following application of the halo-vest alone, odontoid screw alone, and halo-vest and screw combined. Average total neutral zone and total ranges of motion at C0/1 and C1/2 were computed for each experimental condition and statistically compared with physiologic motion limits, obtained from the intact flexibility test. Significance was set at P < 0.05 with a trend toward significance at P < 0.1.
Type II dens fracture caused trends toward increased sagittal neutral zone and lateral bending range of motion at C1/2. Spinal motions with the dens screw alone could not be differentiated from physiologic limits. Significant reductions in motion were observed at C0/1 and C1/2 in flexion-extension and axial rotation due to the halo-vest, applied individually or combined with the dens screw. At C1/2, the halo-vest combined with the dens screw generally allowed the smallest average percentages of intact motion: 3% in axial rotation, 17% in flexion-extension, and 18% in lateral bending.
The present reduction in C1/2 motion observed, due to the halo-vest and dens screw combined is similar to previously reported immobilization provided by the polyaxial screw/rod system and transarticular screw fixation combined with wiring. The present biomechanical data may be useful to clinicians when choosing an appropriate treatment for those with Type II dens fracture. |
| doi_str_mv | 10.1097/BRS.0b013e318195a65b |
| format | Article |
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The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined.
Previous studies have evaluated posterior fixation techniques for stabilizing dens fracture. No previous biomechanical study has investigated the halo-vest and odontoid screw for stabilizing dens fracture.
A biofidelic skull-neck-thorax model was used with 5 osteoligamentous whole cervical spine specimens. Three-dimensional flexibility tests were performed on the specimens while intact, following simulated dens fracture, and following application of the halo-vest alone, odontoid screw alone, and halo-vest and screw combined. Average total neutral zone and total ranges of motion at C0/1 and C1/2 were computed for each experimental condition and statistically compared with physiologic motion limits, obtained from the intact flexibility test. Significance was set at P < 0.05 with a trend toward significance at P < 0.1.
Type II dens fracture caused trends toward increased sagittal neutral zone and lateral bending range of motion at C1/2. Spinal motions with the dens screw alone could not be differentiated from physiologic limits. Significant reductions in motion were observed at C0/1 and C1/2 in flexion-extension and axial rotation due to the halo-vest, applied individually or combined with the dens screw. At C1/2, the halo-vest combined with the dens screw generally allowed the smallest average percentages of intact motion: 3% in axial rotation, 17% in flexion-extension, and 18% in lateral bending.
The present reduction in C1/2 motion observed, due to the halo-vest and dens screw combined is similar to previously reported immobilization provided by the polyaxial screw/rod system and transarticular screw fixation combined with wiring. The present biomechanical data may be useful to clinicians when choosing an appropriate treatment for those with Type II dens fracture.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e318195a65b</identifier><identifier>PMID: 19247169</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Biological and medical sciences ; Biomechanical Phenomena ; Bone Screws ; Cerebrospinal fluid. Meninges. Spinal cord ; External Fixators ; Human viral diseases ; Humans ; Infectious diseases ; Joint Instability - physiopathology ; Joint Instability - surgery ; Joint Instability - therapy ; Medical sciences ; Models, Anatomic ; Neck ; Nervous system (semeiology, syndromes) ; Neurology ; Odontoid Process - injuries ; Odontoid Process - physiology ; Odontoid Process - surgery ; Range of Motion, Articular ; Skull ; Spinal Fractures - physiopathology ; Spinal Fractures - surgery ; Spinal Fractures - therapy ; Spinal Fusion ; Thorax ; Viral diseases ; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2009-03, Vol.34 (5), p.484-490</ispartof><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c364t-1ed87cc438bd0bd376ad9359f4429aa3092104c9687baac2f184c780b2d02ebe3</citedby><cites>FETCH-LOGICAL-c364t-1ed87cc438bd0bd376ad9359f4429aa3092104c9687baac2f184c780b2d02ebe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21205093$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19247169$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>IVANCIC, Paul C</creatorcontrib><creatorcontrib>BEAUCHMAN, Naseem N</creatorcontrib><creatorcontrib>MO, Fred</creatorcontrib><creatorcontrib>LAWRENCE, Brandon D</creatorcontrib><title>Biomechanics of Halo-Vest and Dens Screw Fixation for Type II Odontoid Fracture</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>An in vitro biomechanical study of halo-vest and odontoid screw fixation of Type II dens fracture.
The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined.
Previous studies have evaluated posterior fixation techniques for stabilizing dens fracture. No previous biomechanical study has investigated the halo-vest and odontoid screw for stabilizing dens fracture.
A biofidelic skull-neck-thorax model was used with 5 osteoligamentous whole cervical spine specimens. Three-dimensional flexibility tests were performed on the specimens while intact, following simulated dens fracture, and following application of the halo-vest alone, odontoid screw alone, and halo-vest and screw combined. Average total neutral zone and total ranges of motion at C0/1 and C1/2 were computed for each experimental condition and statistically compared with physiologic motion limits, obtained from the intact flexibility test. Significance was set at P < 0.05 with a trend toward significance at P < 0.1.
Type II dens fracture caused trends toward increased sagittal neutral zone and lateral bending range of motion at C1/2. Spinal motions with the dens screw alone could not be differentiated from physiologic limits. Significant reductions in motion were observed at C0/1 and C1/2 in flexion-extension and axial rotation due to the halo-vest, applied individually or combined with the dens screw. At C1/2, the halo-vest combined with the dens screw generally allowed the smallest average percentages of intact motion: 3% in axial rotation, 17% in flexion-extension, and 18% in lateral bending.
The present reduction in C1/2 motion observed, due to the halo-vest and dens screw combined is similar to previously reported immobilization provided by the polyaxial screw/rod system and transarticular screw fixation combined with wiring. The present biomechanical data may be useful to clinicians when choosing an appropriate treatment for those with Type II dens fracture.</description><subject>Biological and medical sciences</subject><subject>Biomechanical Phenomena</subject><subject>Bone Screws</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>External Fixators</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Joint Instability - physiopathology</subject><subject>Joint Instability - surgery</subject><subject>Joint Instability - therapy</subject><subject>Medical sciences</subject><subject>Models, Anatomic</subject><subject>Neck</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Odontoid Process - injuries</subject><subject>Odontoid Process - physiology</subject><subject>Odontoid Process - surgery</subject><subject>Range of Motion, Articular</subject><subject>Skull</subject><subject>Spinal Fractures - physiopathology</subject><subject>Spinal Fractures - surgery</subject><subject>Spinal Fractures - therapy</subject><subject>Spinal Fusion</subject><subject>Thorax</subject><subject>Viral diseases</subject><subject>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkEtLw0AUhQdRbH38A5HZ6C71ziOTzFKrtQWh4GsbbmYmGEkzdSZB---NtCi4OpvvHA4fIWcMJgx0dnXz-DSBEphwguVMp6jSco-MWcrzhLFU75MxCMUTLoUakaMY3wFACaYPyYhpLjOm9Jgsb2q_cuYN29pE6is6x8Ynry52FFtLb10b6ZMJ7pPO6i_sat_Sygf6vFk7uljQpfVt52tLZwFN1wd3Qg4qbKI73eUxeZndPU_nycPyfjG9fkiMULJLmLN5ZowUeWmhtCJTaLVIdSUl14gCNGcgjVZ5ViIaXrFcmiyHklvgrnTimFxud9fBf_TD3WJVR-OaBlvn-1gopTOVAx9AuQVN8DEGVxXrUK8wbAoGxY_IYhBZ_Bc51M53-325cvavtDM3ABc7AKPBpgrYmjr-cpxxSEEL8Q11VXuQ</recordid><startdate>20090301</startdate><enddate>20090301</enddate><creator>IVANCIC, Paul C</creator><creator>BEAUCHMAN, Naseem N</creator><creator>MO, Fred</creator><creator>LAWRENCE, Brandon D</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090301</creationdate><title>Biomechanics of Halo-Vest and Dens Screw Fixation for Type II Odontoid Fracture</title><author>IVANCIC, Paul C ; BEAUCHMAN, Naseem N ; MO, Fred ; LAWRENCE, Brandon D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c364t-1ed87cc438bd0bd376ad9359f4429aa3092104c9687baac2f184c780b2d02ebe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Biological and medical sciences</topic><topic>Biomechanical Phenomena</topic><topic>Bone Screws</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>External Fixators</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Joint Instability - physiopathology</topic><topic>Joint Instability - surgery</topic><topic>Joint Instability - therapy</topic><topic>Medical sciences</topic><topic>Models, Anatomic</topic><topic>Neck</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Odontoid Process - injuries</topic><topic>Odontoid Process - physiology</topic><topic>Odontoid Process - surgery</topic><topic>Range of Motion, Articular</topic><topic>Skull</topic><topic>Spinal Fractures - physiopathology</topic><topic>Spinal Fractures - surgery</topic><topic>Spinal Fractures - therapy</topic><topic>Spinal Fusion</topic><topic>Thorax</topic><topic>Viral diseases</topic><topic>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>IVANCIC, Paul C</creatorcontrib><creatorcontrib>BEAUCHMAN, Naseem N</creatorcontrib><creatorcontrib>MO, Fred</creatorcontrib><creatorcontrib>LAWRENCE, Brandon D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>IVANCIC, Paul C</au><au>BEAUCHMAN, Naseem N</au><au>MO, Fred</au><au>LAWRENCE, Brandon D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biomechanics of Halo-Vest and Dens Screw Fixation for Type II Odontoid Fracture</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2009-03-01</date><risdate>2009</risdate><volume>34</volume><issue>5</issue><spage>484</spage><epage>490</epage><pages>484-490</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>An in vitro biomechanical study of halo-vest and odontoid screw fixation of Type II dens fracture.
The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined.
Previous studies have evaluated posterior fixation techniques for stabilizing dens fracture. No previous biomechanical study has investigated the halo-vest and odontoid screw for stabilizing dens fracture.
A biofidelic skull-neck-thorax model was used with 5 osteoligamentous whole cervical spine specimens. Three-dimensional flexibility tests were performed on the specimens while intact, following simulated dens fracture, and following application of the halo-vest alone, odontoid screw alone, and halo-vest and screw combined. Average total neutral zone and total ranges of motion at C0/1 and C1/2 were computed for each experimental condition and statistically compared with physiologic motion limits, obtained from the intact flexibility test. Significance was set at P < 0.05 with a trend toward significance at P < 0.1.
Type II dens fracture caused trends toward increased sagittal neutral zone and lateral bending range of motion at C1/2. Spinal motions with the dens screw alone could not be differentiated from physiologic limits. Significant reductions in motion were observed at C0/1 and C1/2 in flexion-extension and axial rotation due to the halo-vest, applied individually or combined with the dens screw. At C1/2, the halo-vest combined with the dens screw generally allowed the smallest average percentages of intact motion: 3% in axial rotation, 17% in flexion-extension, and 18% in lateral bending.
The present reduction in C1/2 motion observed, due to the halo-vest and dens screw combined is similar to previously reported immobilization provided by the polyaxial screw/rod system and transarticular screw fixation combined with wiring. The present biomechanical data may be useful to clinicians when choosing an appropriate treatment for those with Type II dens fracture.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>19247169</pmid><doi>10.1097/BRS.0b013e318195a65b</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0362-2436 |
| ispartof | Spine (Philadelphia, Pa. 1976), 2009-03, Vol.34 (5), p.484-490 |
| issn | 0362-2436 1528-1159 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Biological and medical sciences Biomechanical Phenomena Bone Screws Cerebrospinal fluid. Meninges. Spinal cord External Fixators Human viral diseases Humans Infectious diseases Joint Instability - physiopathology Joint Instability - surgery Joint Instability - therapy Medical sciences Models, Anatomic Neck Nervous system (semeiology, syndromes) Neurology Odontoid Process - injuries Odontoid Process - physiology Odontoid Process - surgery Range of Motion, Articular Skull Spinal Fractures - physiopathology Spinal Fractures - surgery Spinal Fractures - therapy Spinal Fusion Thorax Viral diseases Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye |
| title | Biomechanics of Halo-Vest and Dens Screw Fixation for Type II Odontoid Fracture |
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