title: The effects of hook pattern and kyphotic angulation on mechanical strength and apical rod strain in a long-segment posterior construct using a synthetic model.
abstract: METHODS
  Synthetic spine models were used to compare the effects of hook pattern and kyphotic angulation on stiffness and rod strain in long-segment posterior spinal constructs.
  
  
  OBJECTIVE
  To examine the biomechanical effects of hook patterns and kyphotic angulation on long-segment posterior spinal constructs.
  
  
  BACKGROUND
  Kyphotic deformities managed by increasing rod diameter and hence construct stiffness have shown decreased postoperative loss of correction and hardware complications. The biomechanical effects of hook pattern and kyphosis are unknown.
  
  
  METHODS
  Spine models of 0 degrees, 27 degrees 54 degrees sagittal contour, composed of polypropylene vertebral blocks and isoprene elastomer intervertebral spacers, representing T3-T12, were used for biomechanical testing of long-segment posterior spinal constructs. Models were instrumented with 6.35-mm titanium rods and one of the following hook configurations: 20-hook compression, 16-hook compression, 16-hook claw apex-empty,16-hook claw apex-full, or 8-hook claw. Construct stiffness and rod strain during axial compression were determined.
  
  
  RESULTS
  The compression-hook patterns provided at least a 45% increase in construct stiffness (P = 0.013)and a 22% decrease in rod strain (P < 0.0001) compared with those obtained with the claw-hook pattern with the best biomechanical performance. When analyzing all five hook patterns, there was a 19% decrease in construct stiffness and 27% increase in rod strain when progressing from straight alignment to 27 degrees of sagittal contour (P < 0.0001). Progressing from straight alignment to 54 degrees decreased construct stiffness by 48% and increased rod strain by 55% (P < 0.0001). Construct stiffness was inversely correlated to rod strain in all five hook patterns (R2 = 0.82-0.98, P < 0.001).
  
  
  CONCLUSIONS
  Using compressive-hook patterns and decreasing the kyphotic deformity significantly increases construct stiffness and decreases rod strain.
authors: Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
authors: P J
authors: PJ
authors: Belmont
authors: D W
authors: DW
authors: Polly
authors: B W
authors: BW
authors: Cunningham
authors: W R
authors: WR
authors: Klemme
mesh_terms: D001858:Bone Nails / Q000592:standards*; D006801:Humans; D007738:Kyphosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008953:Models, Anatomic; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013223:Statistics as Topic; D013314:Stress, Mechanical; D013904:Thoracic Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016474:Weight-Bearing / Q000502:physiology