TY - JOUR AU - Henriques , Thomas AU - Cunningham , Bryan W. AU - Mcafee , Paul C. AU - Olerud , Claes PY - 2015/03/06 Y2 - 2024/03/29 TI - <em>In vitro</em> biomechanical evaluation of four fixation techniques for distractive–flexion injury stage 3 of the cervical spine JF - Upsala Journal of Medical Sciences JA - ujms VL - 120 IS - 3 SE - Original Articles DO - 10.3109/03009734.2015.1019684 UR - https://ujms.net/index.php/ujms/article/view/5860 SP - AB - Purpose. Anterior plate fixation has been reported to provide satisfactory results in cervical spine distractive flexion (DF) injuries stages 1 and 2, but will result in a substantial failure rate in more unstable stage 3 and above. The aim of this investigation was to determine the biomechanical properties of different fixation techniques in a DF-3 injury model where all structures responsible for the posterior tension band mechanism are torn.Methods. The multidirectional three-dimensional stiffness of the subaxial cervical spine was measured in eight cadaveric specimens with a simulated DF-3 injury at C5–C6, stabilized with four different fixation techniques: anterior plate alone, anterior plate combined with posterior wire, transarticular facet screws, and a pedicle screw–rod construct, respectively.Results. The anterior plate alone did not improve stability compared to the intact spine condition, thus allowing considerable range of motion around all three cardinal axes (p > 0.05). The anterior plate combined with posterior wire technique improved flexion–extension stiffness (p = 0.023), but not in axial rotation and lateral bending. When the anterior plate was combined with transarticular facet screws or with a pedicle screws–rod instrumentation, the stability improved in flexion–extension, lateral bending, and in axial rotation (p < 0.05).Conclusions. These findings imply that the use of anterior fixation alone is insufficient for fixation of the highly unstable DF-3 injury. In these situations, the use of anterior fixation combined with a competent posterior tension band reconstruction (e.g. transarticular screws or a posterior pedicle screws–rod device) improves segmental stability. ER -