Klaus Röhl, Bernhard Ullrich, Gerd Huber, Michael M. Morlock


September 2009, Volume 18, Issue 9, pp 1335 - 1341 Original Article Read Full Article 10.1007/s00586-009-1087-5

First Online: 09 July 2009

Compared to bicortical screws, the surgical risk of injuring intraspinal structures can be minimized with the use of monocortical screws. However, this reduction should not be achieved at the expense of the stability of the fixation. With monocortical stabilization, the expansion screws have the potential of absorbing high loads. Therefore, they are expected to be a suitable alternative to bicortical screws for revision surgeries and in osteoporotic bone. The purpose of this in vitro study was to investigate the stiffness of the two screw-plate systems used for ventral stabilization of the cervical spine, by focusing on the suitability of expansion screws as tools for revision treatments. The study was conducted in ten functional units of human cervical spines. The device sample stiffness was determined for four conditions using a turning moment of 2.25 N m each around one of the three principle axes. The conditions were native, destabilized, primarily stabilized with one of the screw-plate systems, followed by secondary stabilization using the expansion screw implant. The stabilized samples achieved a comparable, in most cases higher stiffness than the native samples. The samples undergoing secondary stabilization using expansion screws tend to display greater stiffness for all three axes compared to the primarily stabilized samples. The achieved tightening moment of the screws was higher than the one achieved with primary fixation. Both plates revealed similar primary stability. Revision surgeries with secondary instrumentation achieve a high stiffness of the screwed up segments. Monocortical expansion screws combined with a trapezoidal plate allow ventral stabilization of the cervical spine that is comparable to the plate fixation using bicortical screws.


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