Biomechanical study of rod stress in lumbopelvic fixation with lateral interbody fusion: an in vitro experimental study using synthetic bone models.

OBJECTIVE:Despite improvements in surgical techniques and instruments, high rates of rod fracture following a long spinal fusion in the treatment of adult spinal deformity (ASD) remain a concern. Thus, an improved understanding of rod fracture may be valuable for better surgical planning. The authors aimed to investigate mechanical stress on posterior rods in lumbopelvic fixation for the treatment of ASD. METHODS:Synthetic lumbopelvic bone models were instrumented with intervertebral cages, pedicle screws, S2-alar-iliac screws, and rods. The construct was then placed in a testing device, and compressive loads were applied. Subsequently, the strain on the rods was measured using strain gauges on the dorsal aspect of each rod. RESULTS:When the models were instrumented using titanium alloy rods at 30° lumbar lordosis and with lateral interbody fusion cages, posterior rod strain was highest at the lowest segment (L5-S1) and significantly higher than that at the upper segment (L2-3) (p = 0.002). Changing the rod contour from 30° to 50° caused a 36% increase in strain at L5-S1 (p = 0.009). Changing the rod material from titanium alloy to cobalt-chromium caused a 140% increase in strain at L2-3 (p = 0.009) and a 28% decrease in strain at L5-S1 (p = 0.016). The rod strain at L5-S1 using a flat bender for contouring was 23% less than that obtained using a French bender (p = 0.016). CONCLUSIONS:In lumbopelvic fixation in which currently available surgical techniques for ASD are used, the posterior rod strain was highest at the lumbosacral junction, and depended on the contour and material of the rods.