The effect of kyphosis on the mechanical strength of a long-segment posterior construct using a synthetic model

Study Design. This experimental study used synthetic spine models to compare the effect of the angle of kyphosis, rod diameter, and hook number on the biomechanical stiffness of a long-segment posterior spinal construct. Objective. To examine the biomechanical effects of incremental kyphosis on variously instrumented long-segment posterior spinal constructs. Summary of Background Data. Euler's formula for loading of curved long columns would suggest that kyphosis has a profound impact on the biomechanical behavior of long-segment posterior spinal constructs. The effects of sagittal contour on the mechanical properties of long-segment posterior spinal constructs have not been well documented. Methods. Kyphotic and straight synthetic spine models were used to test long-segment posterior instrumentation constructs biomechanically while varying rod diameter and the number of hook sites. The synthetic spines, composed of polypropylene vertebral blocks and isoprene elastomer intervertebral spacers, were fabricated with either 0 degrees, 27 degrees, or 53 degrees of sagittal contour. The models were instrumented with 5.5- or 6.35-mm titanium rods, and with either 8 or 12 hooks. The models were loaded from 0 to 300 N in a cyclical ramp fashion using an MTS 858 Bionix testing device testing device. Construct stiffness (force and displacement) during axial compression was determined. Results. Straight model: Changing the hook number from 8 to 12 caused a 32% increase in construct stiffness with the 5.5-mm rod. Changing the rod diameter from 5.5 to 6.35 mm caused a 36% increase in construct stiffness with the 8-hook pattern. Changing both the rods and hooks caused the stiffness to increase 44%. 27 degrees Model: Changing the hook number from 8 to 12 caused a 20% increase in construct stiffness with the 6.5-mm rod. Changing the rod diameter from 5.5 to 6.35 mm caused a 29% increase in construct stiffness with the 12-hook pattern. Changing both the rods and hooks caused the construct stiffness to increase 26%. 53 degrees Model: Changing the hook number from 8 to 12 caused a 14% increase in construct stiffness with the 6.35-mm rod. Changing the rod diameter from 5.5 to 6.35 mm caused a 17% (P < 0.0005) increase in construct stiffness with the 12-hook-pattern. Changing both rods and hooks caused the stiff ness to increase 21%. Summary data on angular kyphosis: Using the same rod diameter and the same number of hooks, and progressing from a straight alignment to 27 degrees of sagittal contour decreased construct stiffness 32%. Going from straight alignment to 53 degrees decreased the stiffness 59.6%. All reported values were statistically significant (P < 0.0005). Conclusions. The biomechanical stiffness of the straight spine was sensitive to both an increase in hook fixation sites and an increase in rod diameter. The kyphotic spines, however, were more sensitive to variations in rod diameter. Although with increasing kyphosis, the optimum instrumentation strategy will maximize both rod diameter and the number of hook sites, instrumented kyphotic spines remain biomechanically "disadvantaged" as compared with nonkyphotic instrumented spines.