Biomechanical comparison of translaminar versus pedicle screws at T1 and T2 in long subaxial cervical constructs

OBJECTIVE: The first in vitro biomechanical investigation comparing the immediate and postcyclical rigidities of thoracic translaminar versus pedicle screws in posterior constructs crossing the cervicothoracic junction (CTJ). METHODS: Ten human cadaveric spines underwent C4-C6 lateral mass screw and T1-T2 translaminar (n = 5) versus pedicle (n = 5) screw fixation. Spines were then potted in polymethylmethacrylate bone cement and placed on a materials testing machine. Rotation about the axis of bending was measured using passive retroreflective markers and infrared motion capture cameras. The motion of C6 relative to T2 in flexion-extension and lateral bending was assessed uninstrumented, immediately after instrumentation, and after 40,000 cycles of 4 N•m flexion-extension and lateral bending moments at 1 Hz. The effect of instrumentation and cyclical loading on rotational motion across the CTJ was analyzed for significance. RESULTS: Compared with preinstrumented spines, pedicle and translaminar screw constructs significantly (P < 0.001) decreased motion during flexion-extension and lateral bending. After cyclical loading, rotational motion at the CTJ was significantly increased (P < 0.05) during flexion-extension and lateral bending in both groups. With flexion-extension, the mean rotational motion across the CTJ was similar in the translaminar and pedicle constructs immediately after fixation, but slightly greater (P = 0.03) after cyclical loading in the translaminar versus the pedicle screw constructs (0.39 degrees versus 0.26 degrees). Nevertheless, after cyclical loading, the mean angular motion across the CTJ remained less than one half of a degree in both groups. With lateral bending, the mean rotational motion was similar in both translaminar and pedicle screw constructs. CONCLUSION: Both upper thoracic translaminar and pedicle screws allow for rigid fixation at the CTJ. Although translaminar screw constructs demonstrated one eighth of a degree more motion at the CTJ after cycling, this minimal difference is likely less than would influence the biological fusion process. Upper thoracic translaminar screws are a biomechanically effective option to rigidly stabilize the CTJ.