title: Biomechanics of cantilever "plow" during anterior thoracic scoliosis correction.
abstract: BACKGROUND
  Anterior instrumentation is often used for correction of thoracic scoliosis. Loss of spinal correction may occur after failure at the bone-implant interface, and forces on the bone-implant interface during scoliosis correction remain unclear.
  
  
  OBJECTIVE
  Evaluate two different mechanisms of loading associated with anterior scoliosis correction.
  
  
  METHODS
  In vitro biomechanics lab.
  
  
  METHODS
  Polyurethane foam and human cadaveric thoracic vertebral bodies were instrumented with transvertebral body screws. Bone-implant interface failure loads were measured during constrained, fixed-angle screw translation, as well as unconstrained translation allowing coronal plane screw rotation. Vertebral body staples were randomly assigned to both conditions.
  
  
  RESULTS
  Data were consistent across foam and cadaveric specimens. Failures occurred at significantly lower loads during unconstrained translation (with rotation) compared with constrained translation. Staple usage significantly increased the load to failure in both testing modes. In cadaveric bone, the constrained plowing load to failure was 562N+110N versus 188N+20N in the unconstrained testing. With a staple, these values increased to 694N+53N and 530N+100N, respectively.
  
  
  CONCLUSIONS
  The 280% increase in cadaveric failure loads when a staple was added in the unconstrained testing method exceeds previous reports. The unconstrained method of plow simulated anterior scoliosis instrumentation when a rod was cantilevered and compressed into position. Supplemental vertebral body staples may be clinically indicated, particularly at the ends of the construct where residual deforming forces remain the greatest.
authors.affiliation: Children's Hospital, San Diego, MC5054, 3020 Children's Way, San Diego, CA 92123, USA. amahar@chsd.org
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Mahar
authors.forename: David S
authors.initials: DS
authors.lastname: Brown
authors.forename: Richard S
authors.initials: RS
authors.lastname: Oka
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D016267:External Fixators; D006801:Humans; D008422:Materials Testing; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000503:physiopathology / Q000601:surgery*; D016474:Weight-Bearing