Craniovertebral Junction Biomechanical Considerations.

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FIGURE 1
Craniovertebral Junction: Biomechanical Considerations.
Steinmetz, Michael; Mroz, Thomas; Benzel, Edward
Neurosurgery. The Management of Craniovertebral

Junction Disorders. 66(3) Supplement:A7-A12, March
2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 1 . Drawings illustrating primary and mean

movement. A, the primary movement at the occiput-C1 is
flexion and extension. Mean movement is 23 to 24.5
degrees. B, the primary movement at C1-C2 is axial
rotation; mean movement is 23.3 to 38.9 degrees. C,
flexion/extension at C1-C2 ranges from 10.1 to 22.4
degrees. (Reprinted from Benzel EC, ed. Biomechanics of
Spine Stabilization. Rolling Meadows, IL: AANS Press;
2001,34 with permission from Thieme Publishers.)
Copyright © by the Congress of Neurological Surgeons. Published by Lippincott Williams & Wilkins, Inc. 2
FIGURE 2

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 2 . T1-weighted magnetic resonance imaging scan

(lateral view) of the craniovertebral junction. A
destructive lesion of the odontoid process is seen.
FIGURE 3

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 3 . Drawing showing that the anatomy of the

occiput-C1-C2 region makes fixation of this region very
difficult. (Reprinted from Benzel EC, ed. Biomechanics of
Spine Stabilization. Rolling Meadows, IL: AANS Press;
FIGURE 4

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 4 . Intraoperative photograph illustrating that

current-day occipitocervical constructs incorporate
polyaxial screws placed in the cervical spine (small blue
arrow) and, usually, a plate connected to the suboccipital
bone (large blue arrow). These are usually connected by
titanium rods.
FIGURE 5

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 5 . Drawings illustrating that occipitocervical

constructs may consist of plates connected from the
occiput to the cervical spine, usually by screws;
alternatively, wires may be used as well. A, because these
screws are placed in line with the C1 and C2 screws,
fixation is somewhat easier. B, longitudinal members may
be cross-linked. C, a downside of lateral fixation is that
the lateral suboccipital bone is much less thick as
compared with the midline keel. Only short screws may
be placed in the lateral bone, making fixation somewhat
less robust. (Reprinted from Benzel EC, ed. Biomechanics
of Spine Stabilization. Rolling Meadows, IL: AANS Press;
FIGURE 6

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 6 . Lateral intraoperative radiograph. Fixation of

C1 may be accomplished by lateral mass fixation. Pullout
resistance is greater as compared with wires. (Courtesy
of Iain Kalfas, MD.)
FIGURE 7

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 7 . Drawing (A) and lateral x-ray (B) showing that

rods may be affixed to the occiput-C1-C2 via wires.
(Reprinted from Benzel EC, ed. Biomechanics of Spine
Stabilization. Rolling Meadows, IL: AANS Press; 2001,34
with permission from Thieme Publishers.)
FIGURE 8

2010.
DOI: 10.1227/01.NEU.0000366109.85796.42
FIGURE 8 . Drawing showing that fixation to the cervical

spine may be via transarticular screws. Biomechanically,
this construct provides significant stability in
flexion/extension and rotation. (Reprinted from Benzel
EC, ed. Biomechanics of Spine Stabilization. Rolling
Meadows, IL: AANS Press; 2001,34 with permission from
Thieme Publishers.)

Craniovertebral Junction Biomechanical Considerations.

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Neurosurgery. The Management of Craniovertebral

FIGURE 1 . Drawings illustrating primary and mean

Neurosurgery. The Management of Craniovertebral

FIGURE 2 . T1-weighted magnetic resonance imaging scan

Neurosurgery. The Management of Craniovertebral

FIGURE 3 . Drawing showing that the anatomy of the

Neurosurgery. The Management of Craniovertebral

FIGURE 4 . Intraoperative photograph illustrating that

Neurosurgery. The Management of Craniovertebral

FIGURE 5 . Drawings illustrating that occipitocervical

Neurosurgery. The Management of Craniovertebral

FIGURE 6 . Lateral intraoperative radiograph. Fixation of

Neurosurgery. The Management of Craniovertebral

FIGURE 7 . Drawing (A) and lateral x-ray (B) showing that

Neurosurgery. The Management of Craniovertebral

FIGURE 8 . Drawing showing that fixation to the cervical

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