Biomechanical evaluation of the craniovertebral junction after odontoidectomy with anterior C1 arch preservation: A finite element study

Objective: Odontoidectomy with preservation of the anterior C1 arch can be increasingly achieved by an endo-scopic endonasal approach. It is controversial whether preservation of the anterior C1 arch after odontoidectomy can prevent instability of the craniovertebral junction (CVJ) and avoid posterior fixation. The aim of this research was to investigate the biomechanical effect of the preserved anterior C1 arch after odontoidectomy. Methods: A validated finite element model of a whole cervical spine (occipital bone to T1) was constructed to study the biomechanical changes due to traditional odontoidectomy (TO) and odontoidectomy with preservation of the anterior C1 arch (OPC1). Results: The greatest biomechanical changes in the cervical spine model after TO and OPC1 occurred at C0-C1 and C1-C2. At C0-C1 and C1-C2, the motion changes of the TO and OPC1 models had no significant differ-ence in flexion, extension and lateral bending. Compared with the intact model, motion increases of the two surgical models were both extremely significant at C1-C2 in extension (128.2% vs. 128.1%) and lateral bending (178% vs. 156%). In axial rotation, the TO approach produced more motions than the OPC1 approach, especially at C1-C2(90.3 degrees under TO approach, and 74.6 degrees under OPC1 approach). Conclusions: Preservation of the anterior C1 arch after odontoidectomy can preserve the axial rotational motion at C0-C1 and C1-C2, whereas the motions in extension and lateral bending continue to have an extremely abnormal increase at C1-C2. Thus, instability of the CVJ still exists, and posterior internal fixation may also be required after OPC1.