title: Novel dual-rod screw for thoracoscopic anterior instrumentation: biomechanical evaluation compared with single-rod and double-screw/double-rod anterior constructs.
abstract: METHODS
  A novel dual-rod screw was designed to provide a second-rod augmentation at the critical apical/middle segments of the single-rod thoracoscopic anterior construct. Biomechanical testing was performed on pig thoracic spines instrumented with 7-segment anterior scoliosis constructs.
  
  
  OBJECTIVE
  To analyze the biomechanical performance of the new implant, and compare it to a single-rod and double-rod anterior constructs.
  
  
  BACKGROUND
  Using single-rod thoracoscopic anterior instrumentation for thoracic scoliosis, the complications of rod breakage at apex, high rate of nonunion, and resultant loss of coronal and sagittal correction has been reported. Inadequate construct stiffness because of a smaller diameter single rod has been implicated as the cause of these complications.
  
  
  METHODS
  Twelve pig thoracic spines were instrumented over 7 segments with: (1) single-rod construct, (2) short second-rod augmentation at the apex of the single-rod construct, (3) long second-rod augmentation at middle segments of the single-rod construct, and (4) double-screw/double-rod anterior construct. The spines were tested in flexion-extension, left-right lateral bending, and torsion, using pure bending moments. Strain gauges attached to the primary single rod at the cephalad, middle, and caudal portions were used and the maximum tensile stress was recorded.
  
  
  RESULTS
  In the single-rod construct, the middle portion stress was 39% to 51% greater than the stress in the cephalad and caudal portions in flexion-extension (P < 0.05), and the cephalad portion stress was 39% to 65% greater than the stress in the middle and caudal portions in right lateral bending and torsion (P < 0.05). When a second rod was added at the apical/middle portion, the middle portion stress decreased from 50% to 72% in flexion-extension and right lateral bending (P < 0.05). In addition, the second rod decreased the primary single-rod stress at the cephalad portion by 48% (left torsion) and the caudal portion by 50% (flexion). Double-screw/double-rod construct significantly increases the construct stiffness in comparison with the single-rod construct. However, it did not add any construct stiffness at the critical apical segments when compared to the constructs in which the second rod augmented the single-rod constructs.
  
  
  CONCLUSIONS
  A novel dual-rod screw was designed to combine the standard single-rod construct with the addition of a second rod at the critical apical/middle segments and increase construct stiffness and stability. This implant may therefore prevent pseudarthrosis and rod breakage by enhancing construct stiffness.
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA. hong.zhang@tsrh.org
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
authors.forename: William A
authors.initials: WA
authors.lastname: Pierce
authors.forename: David
authors.initials: D
authors.lastname: Ross
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D001863:Bone Screws; D001864:Bone Wires; D019544:Equipment Failure Analysis; D008954:Models, Biological; D011474:Prosthesis Design; D011542:Pseudarthrosis / Q000503:physiopathology / Q000517:prevention & control; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013552:Swine; D013718:Tensile Strength; D013904:Thoracic Vertebrae / Q000502:physiology / Q000601:surgery*