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Biomechanical investigation of intra-articular cage and cantilever technique in the treatment of congenital basilar invagination combined with atlantoaxial dislocation: a finite element analysis

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Abstract

Biomechanical effect of posterior intra-articular cages and cantilever technique on the congenital basilar invagination (BI) combined with atlantoaxial dislocation (AAD) was investigated and evaluated using finite element (FE) analysis. A 3D nonlinear occipitocervical segment C0–C3 FE models of congenital BI and AAD was established. Then, the FE model treated with C2 pedicle screw and occipital plate fixation coupled with intra-articular cages (Cage + C2PS + OP) was compared to that without intra-articular cages (C2PS + OP). The range of motion (ROM) of C0C1–C2 and the maximum von Mises stresses (MVMS) on the intra-articular cages, screw-plate system, and C2 endplate were calculated and compared to further analyze the stability of atlantoaxial joint and assess the collapse and fracture risks of intra-articular cages and screw-plate system. ROM of C0C1–C2 segment was reduced by 57.58%, 63.33%, 78.18%, and 75.90%, and the peak stresses of C2 pedicle screw and occipital plate were decreased by 84.86%, 72.90%, 73.24%, and 84.90% and 78.35%, 76.64%, 81.82%, and 89.49% for Cage + C2PS + OP model in flexion, extension, lateral bending, and axial rotation when compared with the C2PS + OP model under the same condition. The MVMS of intra-articular cages were 13.80 MPa, 40.26 MPa, 26.93 MPa, and 17.50 MPa and those of C2 endplate were 14.56 MPa, 34.80 MPa, 36.29 MPa, and 37.56 MPa in Cage + C2PS + OP model under same conditions. Posterior intra-articular cages and cantilever technique to treat BI-AAD can improve the stability of the atlantoaxial joint and reduce the risk of screw-plate breakage. The intra-articular cages can not only complement the height loss on account of atlantooccipital fusion but also provide stable support for posterior fixation fusion.

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Funding

This research was supported by the National Natural Science Foundation of China (no. 11502146), the Shanghai Natural Science Foundation (no. 15ZR1429600) and Beijing Hospitals Authority Clinical medicine Development of Special Funding (no. XMLX202138).

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Authors and Affiliations

  1. School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China

    Gaiping Zhao, Mei Song & Yaru Xue

  2. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

    Wanru Duan & Zan Chen

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  1. Gaiping Zhao
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  2. Mei Song
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Correspondence to Gaiping Zhao.

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Zhao, G., Song, M., Duan, W. et al. Biomechanical investigation of intra-articular cage and cantilever technique in the treatment of congenital basilar invagination combined with atlantoaxial dislocation: a finite element analysis. Med Biol Eng Comput 60, 2189–2199 (2022). https://doi.org/10.1007/s11517-022-02596-y

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