title: Effect of severity of rod contour on posterior rod failure in the setting of lumbar pedicle subtraction osteotomy (PSO): a biomechanical study.
abstract: BACKGROUND
  Rod failure has been reported clinically in pedicle subtraction osteotomy (PSO) to correct flat back deformity.
  
  
  OBJECTIVE
  To characterize the fatigue life of posterior screw-rod constructs in the setting of PSO as a function of the severity of rod contour angle.
  
  
  METHODS
  A modified ASTM F1717 to 04 was used. Rods were contoured to the appropriate angle for the equivalent 20-, 40-, or 60-degree PSO angles. Testing was performed on a mechanical test frame at 400/40 N and 250/25 N, and specimens were cycled at 4 Hz to failure or run-out at 2,000,000 cycles. The effect of the screw-rod system on fatigue strength of curved rods was compared using Cox proportional hazards regression.
  
  
  RESULTS
  At 400 N/40 N, Cox proportional hazards regression indicated that contouring rods from a 20-degree PSO angle to either 40 or 60 degrees significantly decreased fatigue life (hazard ratio = 7863.6, P = .0144). However, contouring rods from a 40-degree PSO angle to 60 degrees had no significant effect on the fatigue life (P > .05). At 250 N/25 N, Cox proportional hazards regression indicated that contouring rods from a 20-degree PSO angle to either 40 or 60 degrees significantly decreased fatigue life (hazard ratio = 7863.6, P = .0144). Furthermore, contouring rods from a 40-degree PSO angle to 60 degrees had a significant effect on the fatigue life (hazard ratio = 7863.6, P = .0144).
  
  
  CONCLUSIONS
  Results suggest that in the setting of PSO, the fatigue life of posterior spinal fixation rods depends largely on the severity of the rod angle used to maintain the vertebral angle created by the PSO and is significantly lowered by rod contouring.
authors.affiliation: The Taylor Collaboration, San Francisco, California 94117, USA. jtang@taylorcollaboration.org
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Tang
authors.forename: Jeremi M
authors.initials: JM
authors.lastname: Leasure
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Jenni M
authors.initials: JM
authors.lastname: Buckley
authors.forename: Dimitriy
authors.initials: D
authors.lastname: Kondrashov
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D001696:Biomechanical Phenomena; D001863:Bone Screws / Q000009:adverse effects*; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis; D010027:Osteotomy / Q000379:methods; D016016:Proportional Hazards Models; D013123:Spinal Fusion / Q000295:instrumentation*; D013314:Stress, Mechanical