Biomechanical comparison between C-7 lateral mass and pedicle screws in subaxial cervical constructs: Presented at the 2009 Joint Spine Meeting - Laboratory investigation

Risheng Xu, Matthew J. McGirt, Edward G. Sutter, Daniel M. Sciubba, Jean Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Object. The aim of this study was to conduct the first in vitro biomechanical comparison of immediate and postcyclical rigidities of C-7 lateral mass versus C-7 pedicle screws in posterior C4-7 constructs. Methods. Ten human cadaveric spines were treated with C4-6 lateral mass screw and C-7 lateral mass (5 specimens) versus pedicle (5 specimens) screw fixation. Spines were 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 C-4 relative to C-7 in flexion-extension and lateral bending was assessed uninstrumented, immediately after instrumentation, and following 40,000 cycles of 4 Nm of flexion-extension and lateral bending moments at 1 Hz. The effect of instrumentation and cyclical loading on rotational motion across C4-7 was analyzed for significance. Results. Preinstrumented spines for the 2 cohorts were comparable in bone mineral density and range of motion in both flexion-extension (p = 0.33) and lateral bending (p = 0.16). Lateral mass and pedicle screw constructs significantly reduced motion during flexion-extension (11.3°-0.26° for lateral mass screws, p = 0.002; 10.51°-0.30° for pedicle screws, p = 0.008) and lateral bending (7.38°-0.27° for lateral mass screws, p = 0.003; 11.65°-0.49° for pedicle screws, p = 0.03). After cyclical loading in both cohorts, rotational motion over C4-7 was increased during flexion-extension (0.26°-0.68° for lateral mass screws; 0.30°-1.31° for pedicle screws) and lateral bending (0.27°-0.39° and 0.49°-0.80°, respectively), although the increase was not statistically significant (p > 0.05). There was no statistical difference in postcyclical flexion-extension (p = 0.20) and lateral bending (0.10) between lateral mass and pedicle screws. Conclusions. Both C-7 lateral mass and C-7 pedicle screws allow equally rigid fixation of subaxial lateral mass constructs ending at C-7. Immediately and within a simulated 6-week postfixation period, C-7 lateral mass screws may be as effective as C-7 pedicle screws in biomechanically stabilizing long subaxial lateral mass constructs.

Original languageEnglish (US)
Pages (from-to)688-694
Number of pages7
JournalJournal of Neurosurgery: Spine
Issue number6
StatePublished - Dec 2010


  • Biomechanics
  • Fusion
  • Lateral mass screw
  • Pedicle screw
  • Posterior instrumentation
  • Subaxial instability

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology


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