ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Biomechanical differences between occipital plate and modified C1 lateral mass screw in the treatment of complex craniocervical malformations: a finite element analysis.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundComplex craniocervical malformations pose significant challenges to surgical fixation. The biomechanical advantage of occipital plate fixation versus short-lever modified C1 lateral mass screw fixation remains controversial, and finite element analysis (FEA) is a reliable tool for implant performance evaluation.
objectiveTo compare biomechanical characteristics of occipital plate fixation and modified C1 lateral mass screw fixation in AOZ-BI and AOZ-AAD models via FEA, and guide surgical decision-making.
methodsA validated healthy occipito-atlantoaxial (C0-C2) FEA model was established using CT data. Two pathological models were constructed: AOZ-BI (Group A, atlantoaxial distance [ADI] < 5 mm) and AOZ-AAD (Group B, ADI ≥ 5 mm with transverse ligament dysfunction), each divided into occipital plate and modified C1 lateral mass screw subgroups. Static loads (40 N preload + 1.5 N·m torque) simulated flexion (Fe), extension (Ex), lateral bending (LB), and axial rotation (AR). C1-C2 range of motion (ROM) and screw-rod peak Von Mises stress (PVMS) were measured.
resultsModified C1 lateral mass screw fixation reduced C1-C2 ROM by 19.67% (flexion-extension) to 48.51% (lateral bending) compared with occipital plate fixation. In flexion/extension/axial rotation, C1 lateral mass screw fixation increased screw-rod peak Von Mises stress (PVMS) by 51.17%-131.37% in the AOZ-BI group and 36.51%-56.02% in the AOZ-AAD group; in lateral bending, PVMS decreased by 19.46% in the AOZ-BI group but increased by 5.24% in the AOZ-AAD group. occipital plate fixation consistently had higher ROM (Group B highest) but lower PVMS.
conclusionsModified C1 lateral mass screw fixation provides superior C1-C2 stability for AOZ-associated BI-AAD but increases implant stress in Fe/Ex/AR. Occipital plate fixation is less stable but reduces stress. Clinically, C1 lateral mass screw is preferred for AOZ-BI; AOZ-AAD requires balancing stability and stress risk. Occipital plate suits patients with severe C1 lateral mass hypoplasia. FEA effectively evaluates craniocervical fixation biomechanics.
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