Oblique Cervical Wiring: Technique Modification with Biomechanical Failure Testing

Fred H Geisler, MD, PhD
Mitchell R. Gropper MD
Daniel T Laitch, DO (Detroit, MI)
Daniel lvankovich, MD

Introduction:

Previously described methods of cervical facet wiring fail at the inferior articular process. These methods do not allow enough force generation to reduce significant traumatic deformity. A modified technique of oblique cervical wiring was tested to failure in a bovine model and the technique was applied in 8 cases.

Methods and Materials:

Twenty bovine spines underwent oblique cervical wiring incorporating the facets and the subjacent spinous process. On the left side, the new technique was employed incorporating the lateral aspect of the inferior articular process. Contralaterally, the standard oblique wiring technique was used. The wires were then statically loaded to failure ("pull–through" or fracture) and results were compared. Eight patients underwent this technique.

Results:

A significant increase in the force to failure was seen with the new technique. Failure of the standard technique was seem at 33 pounds (SD 4.2 pounds) while the new construct did not fail until wire tension reached 11 7 pounds (SD 18.7 ponds). The new technique failed only after fracture of the entire joint complex from the pedicle. in patients subjected to this method, deformity correction held in the postoperative setting until fusion was achieved.

Discussion & Conclusions:

This modification of the standard oblique wiring technique can be utilized in cervical trauma cases deemed appropriate for posterior fixation. The method is simple, safe, efficacious, and has the added advantage of allowing the surgeon to correct deformity.