A Biomechanical Analysis of Instrumentation Constructs During Vertebral Column Resection: Stability When You Need It!

Abstract

Study design: Biomechanical Testing.

Objective: Investigate the optimal construct for stabilization of the spine during vertebral column resection (VCR).

Summary of background data: VCR is a powerful technique for achieving correction in severe cases of spinal deformity. However, this also creates an unstable spine which requires stable fixation to prevent iatrogenic neurologic injury. It is common practice to place a temporary unilateral rod configuration to achieve this stability during surgery but no study to date has investigated the optimal construct configuration.

Methods: A unilateral VCR model representing an acute 50° kyphotic deformity with a standardized 30 mm resection was created. Three conditions underwent testing: 1) Rod material and diameter, 2) rod configuration, and 3) number of fixation points. Six unique samples were tested in each group in both flexion-extension. Prior to testing a 10N preload and underwent cyclical testing in flexion/extension. System stiffness was calculated and compared across groups.

Results: Assessment of rod size and composition using a single screw construct (2 total screws) demonstrated that for Titanium (Ti) rods, increasing rod size significantly increased the construct stiffness (P=0.001). Although Cobalt-chromium (Co-Cr) rods where significantly stiffer than the corresponding sized Ti rods, there was no significant difference between rod diameters for Co-Cr (P=0.98). However, when tested using a dual screw (4 total screws) construct, these constructs were significantly stiffer than the corresponding single screw constructs (P<0.0001). Of the various rod configurations, the dual rod demonstrated the greatest stiffness (34.8±2.1 N/mm; P<0.0001).

Conclusion: Surgical construct stiffness during a VCR is multifactorial. Larger rod diameter, increased number of fixation points, stiffer rod material, and increased number of rods across the resection site increase the construct stiffness. With minimal points of fixation using Co-Cr rods, increasing rod diameter does not impart greater construct stiffness unless additional fixation points are included.