Biomechanical analysis of clinical stability in the cervical spine.

This study was undertaken because there is a dearth of objective information in the literature on the clinical instability of the cervical spine below C2. To our knowledge, it is the first biomechanical investigation designed to analyze clinical stability. We have carried out a quantitative analysis of the behavior of the spine as a function of the systematic destruction of various anatomic elements. Under controlled conditions designed to maintain the biological integrity of the specimens, 17 motion segments from 8 cervical spines were analyzed. The spines were studied with either flexion or extension simulated using physiologic loads. Some of the more important findings are: (1) In sectioning the ligaments, one observes small increments of change followed without warning by sudden, complete disruption of the spine; (2) Removal of the facets alters the motion segment such that in flexion, there is less angular displacement and more horizontal displacement; (3) The anterior ligaments contribute more to stability in extension than the posterior ligaments and in flexion, the converse is true; (4) The adult cervical spine is unstable, or on the brink of instability, when any of the following conditions are present: a) All the anterior or all the posterior elements are destroyed or unable to function. b) More than 3.5 mm horizontal displacement of one vertebra in relation to an adjacent vertebra measured on lateral roentgenograms (resting or flexion-extension). c) More than 11 degrees of rotation difference to that of either adjacent vertebra measured on a resting lateral or flexion-extension roentgenogram. These findings can be aptly applied to clinical situations and when instability as determined by the above criteria is present, surgical fusion or some other method to achieve stability should be seriously considered. Work is continuing on this problem as we do not consider this to be altogether complete or definitive. Hopefully, this initial study will stimulate further scientific and clinical investigations.