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<p>Atlantoaxial instability (AAI) necessitates surgical stabilization to prevent neurological compromise. This finite element study compares the biomechanical performance of four atlantoaxial fixation constructs under physiological loading: standalone atlantoaxial cage (AAC), C1–C2 pedicle screws (C1–C2 PS), C1 pedicle screws with transarticular screws (C1 PS + TA), and a combined 360° construct (C1–C2 PS + AAC). A validated C0–C7 FE model with simulated AAI was subjected to flexion, extension, lateral bending, and axial rotation. Results demonstrated that the 360° construct provided the highest stability, with the lowest range of motion in all directions. It also significantly reduced peak von Mises stress on screws (by up to 91.7%) and cages (by up to 57.2%) compared to standalone constructs, while minimizing vertebral stress (over 90% reduction vs. C1–C2 PS). Adjacent disc stress remained largely unaffected by fixation type, with consistent stress concentrations at the C2–C3 level. The C1–C2 PS + AAC configuration offers superior biomechanical stability, enhanced load sharing, and reduced implant and bone stress, supporting its potential as an optimal strategy for complex AAI fixation.</p>

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Comparison of the effects of four atlantoaxial fusions on adjacent segments

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月26日

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  • Nanjian Xu,
  • Yang Wang,
  • Weihu Ma,
  • Jun Gu

摘要

Atlantoaxial instability (AAI) necessitates surgical stabilization to prevent neurological compromise. This finite element study compares the biomechanical performance of four atlantoaxial fixation constructs under physiological loading: standalone atlantoaxial cage (AAC), C1–C2 pedicle screws (C1–C2 PS), C1 pedicle screws with transarticular screws (C1 PS + TA), and a combined 360° construct (C1–C2 PS + AAC). A validated C0–C7 FE model with simulated AAI was subjected to flexion, extension, lateral bending, and axial rotation. Results demonstrated that the 360° construct provided the highest stability, with the lowest range of motion in all directions. It also significantly reduced peak von Mises stress on screws (by up to 91.7%) and cages (by up to 57.2%) compared to standalone constructs, while minimizing vertebral stress (over 90% reduction vs. C1–C2 PS). Adjacent disc stress remained largely unaffected by fixation type, with consistent stress concentrations at the C2–C3 level. The C1–C2 PS + AAC configuration offers superior biomechanical stability, enhanced load sharing, and reduced implant and bone stress, supporting its potential as an optimal strategy for complex AAI fixation.