Effect of spinal construct stiffness on short segment fusion mass incorporation

Study Design Three segment (L3-L5) pedicle screw constructs were implanted in caprine spines, and the resulting ankylosis evaluated mechanically and compared 12 weeks after surgery.Objectives To determine if a construct of maximal stiffness could impair the biologic process of spinal arthrodesis by “stress-shielding.” Summary of Background Data Fusion mass stiffness is believed to be enhanced by increasing construct stiffness, although previous studies have used semirigid, nonconstrained constructs, which lose stiffness through cyclical loading. Device-related osteoporosis, reported to occur with stiff, constrained implants, may be more related to the presence of fusion induced by the implants rather than the implants themselves. Methods In 15 goats, L3-L5 segments were instrumented with pedicle screws, and four different diameters of rods (3.2 cm, 4.8 cm, 6.4 mm, and no rods) were implanted as longitudinal connections to vary the stiffness of the constructs. After 12 weeks, animals were killed and the segments were tested to determine their stiffness. Results In lateral bending, spines “fused” with rods (any size) were significantly stiffer (P<0.03) than nonrodded spines. There was a trend toward stiffer segments with larger rods (4.8 cm or 6.4 mm) compared with 3.2 mm or no rods. There was a highly significant (P< 0.0001) increase in stiffness of all operated (rodded or nonrodded) segments compared with unoperated controls. Conclusions The enhancement of segmental stiffness by stiffer constructs was confirmed, suggesting a beneficial effect on spinal arthodesis by increasing stiffness, Stress shielding could not be shown.