New rod-plate anterior instrumentation for thoracolumbar/lumbar scoliosis: biomechanical evaluation compared with dual-rod and single-rod with structural interbody support.

STUDY DESIGN: A new rod-plate anterior implant was designed to provide plate fixation at the cephalad and caudal-end segments of a 5-level anterior spine construct. Biomechanical testing was performed on calf spines instrumented with 5-segment anterior scoliosis constructs. OBJECTIVES.: To analyze the initial and post-fatigue biomechanical performance of the new implant, and compare it to an anterior dual-rod construct and a single-rod construct with interbody cages. SUMMARY OF BACKGROUND DATA: Using single-rod anterior instrumentation for thoracolumbar and lumbar scoliosis, an unacceptable incidence of loss of correction, segmental kyphosis, and pseudarthrosis has been reported. Inadequate construct stiffness due to early postoperative bone-screw interface failure, especially at cephalad and caudal-end vertebrae, has been implicated as the cause of these complications. METHODS: Thirty calf spines were instrumented over 5 segments with: (1) single-rod augmented with rod-plate implants, (2) dual-rod construct, and (3) single-rod with titanium mesh cages. Stiffness in flexion-extension and lateral bending modes was determined initially and post-cyclical loading by measuring segmental range of motion (ROM). Post-fatigue screw pullout tests were also performed. RESULTS: In lateral bending, the caudal-end segmental ROM for rod-plate construct was 54% less than single-rod with cages construct (P < 0.05), with no difference between rod-plate and dual-rod constructs. In flexion-extension, the rod-plate construct showed 45% to 91% (initial test) and 84% to 90% (post-fatigue) less ROM than the single-rod with cages construct (P < 0.001). Again, there was no difference between rod-plate and dual-rod constructs at the cephalad and caudal-end segments. Post-fatigue screw pullout strengths of the rod-plate construct were significantly greater than those of the dual-rod and single-rod with cages constructs (P < 0.05). CONCLUSIONS: The rod-plate construct was significantly stiffer and provided greater stability of bone-screw interface than the single-rod with cages construct. It achieved similar stiffness and improved bone-screw interface stability compared to dual-rod construct.

Stability of external circular fixation: a multi-variable biomechanical analysis.

OBJECTIVE: To determine how the manipulation of the parameters of fixation and components of the circular external frame could improve and maintain optimal stability of bone fragments. DESIGN: We performed a multi-parametric biomechanical analysis of the extrinsic parameters effecting bone fragment stabilization. Results of testing are presented as a percent change in stiffness due to the manipulation of frame components and their interaction with other fixation parameters. BACKGROUND: Although there have been investigations of the biomechanical characteristics of circular external fixation, they have been limited to either individual frame components or full frame comparisons. Therefore, these studies did not provide a comprehensive understanding of how the manipulation of circular fixator components influences bone fragment stability. METHODS: Mechanical testing was performed in three phases examining the effect of numerous components including ring diameter, wire angle, ring separation, etc. on axial, torsional and bending stiffness. RESULTS: For phase I (single ring) and phase II (double-ring block), ring diameter was the most significant factor affecting axial and torsional stiffness, while wire angle, ring separation, and their interaction had the most influence on bending stiffness. Phase III (two double-ring blocks) showed that ring positioning with respect to the osteotomy site had the most affect on bending and torsional stiffness while axial stiffness was non-linear and dependent upon the applied load. CONCLUSIONS: The stability of bone fragments within a circular external fixator is affected by manipulation of the parameters of fixation or individual components of the frame. The contribution of each component to overall bone fragment stability is dependent upon the mode of loading. The changes in overall stability of bone fragments are dependent not only on the individual frame components but also upon their interaction with other parameters of fixation. RELEVANCE: Understanding how the manipulation of individual frame components will affect overall bone fragment stabilization will allow the surgeon to better control the stability of bone fragments for each clinical situation.