In vitro biomechanical comparison of multistrand cables with conventional cervical stabilization.

STUDY DESIGN

The biomechanical stability of six different methods of cervical spine stabilization, three using multistrand cables, were evaluated in a bovine model.

OBJECTIVES

To quantify and compare the in vitro biomechanical properties of multistrand cables used for posterior cervical wiring to standard cervical fixation techniques.

SUMMARY OF BACKGROUND DATA

Fixation of the posterior cervical spine with monofilament stainless steel wire is a proven technique for stabilization of the cervical spine. Recently, multistrand braided cables have been used as a substitute for monofilament stainless steel wires. These cables, made of stainless steel, titanium, or polyethylene, are reported to be stronger, more flexible, and fatigue resistant than are monofilament wire based on mechanical testing. However, no in vitro biomechanical studies have been performed testing a standard posterior cervical wiring technique using multistrand cables.

METHODS

Thirty-six fresh frozen cervical calf spines consistent in size and age were mounted and fixed rigidly to isolate the C4-C5 motion segment. Six different reconstruction techniques were evaluated for Rogers' posterior cervical wiring technique using: 1) 20-gauge stainless steel monofilament wire, 2) stainless steel cable, 3) titanium cable, 4) polyethylene cables, 5) anterior locking plate construct with interbody graft, and 6) posterior plate construct. Six cervical spines were included in each group (n = 6), with each specimen statically evaluated under three stability conditions: 1) intact, 2) reconstructed, and 3) postfatigue. The instability model created before the reconstruction consisted of a distractive flexion Stage 3 injury at C4-C5. Nondestructive static biomechanical testing, performed on an material testing machine (MTS 858 Bionix test system, Minneapolis, MN), included axial compression, axial rotation, flexion-extension, and lateral bending. After reconstruction and static analysis, the specimens were fatigued for 1500 cycles and then statically retested. Data analysis included normalization of the reconstructed and postfatigue data to the intact condition. The calculated static parameters included operative functional unit stiffness and range of motion.

RESULTS

Posterior cervical reconstruction with stainless steel monofilament wire proved inadequate under fatigue testing. Two of the six specimens failed with fatigue, and this construct permitted the greatest degree of flexion-extension motion after fatigue in comparison with all other constructs (P < 0.05). There were no significant differences in flexural stiffness or range of motion between stainless steel, titanium, or polyethylene cable constructs before or after fatigue testing. The posterior cervical plate constructs were the stiffest constructs under flexion, extension, and lateral bending modes, before and after fatigue testing (P < 0.05).

CONCLUSIONS

Multistrand cables were superior to monofilament wire with fatigue testing using an in vitro calf cervical spine model. There were no failures or detectable differences in elongation after fatigue testing between the stainless steel, titanium, and polyethylene cables, as shown by the flexion-extension range of motion. The posterior cervical plate construct offered the greatest stability compared with all other constructs.