The memory properties of cold-worked titanium rods in scoliosis constructs

Shape Loss of Autoclaved, Machine-Bent Cobalt-Chrome and Titanium Spine Surgery Rods

STUDY DESIGN

This was a biomechanical study.

OBJECTIVE

Shape loss of surgical spine rods has been implicated as a factor leading to postsurgical loss of alignment correction. Our objective was to compare the degree of shape loss in surgical spine rods of different compositions under physiological conditions that were bent before or after being autoclaved.

METHODS

10 CoCr and 10 commercially pure titanium (CPTi) surgical spine rods were contoured using a machine press. Five CoCr and 5 CPTi rods were bent before being autoclaved (preoperative bent group); 5 CoCr and 5 CPTi rods were bent after being autoclaved (intraoperative bent group). All rods were immersed in a phosphate-buffered saline bath at body temperature (37.2°C ± 2°C). Changes in radius of curvature were measured at different time intervals over an 8-week course using a high-definition scanner.

RESULTS

Each rod demonstrated shape loss in radius of curvature (range = 1.04-9.99 mm) over the duration of the study. Intraoperatively bent CPTi rods demonstrated the largest shape loss (range = 8.73-9.99 mm; median 9.33 mm; P < .01). Preoperatively bent CPTi (range = 1.04-1.71 mm; median = 1.39 mm; P < .01) and intraoperatively bent CoCr (range = 1.11-2.11 mm; median = 2.01 mm; P < .01) rods underwent the least amount of shape loss.

CONCLUSION

CPTi spinal rods bent after autoclave may lead to considerable loss of alignment correction. In addition, our results suggest that preautoclave bent CPTi and CoCr spinal rods bent after autoclave may be a more ideal choice of implant because they may provide more resistance to shape loss over time.

Choice of Rods in Surgical Treatment of Adolescent Idiopathic Scoliosis: What Are the Clinical Implications of Biomechanical Properties? - A Review of the Literature

The surgical treatment of adolescent idiopathic scoliosis (AIS) involves 3-dimensional curve correction with multisegmental pedicle screws attached to contoured bilateral rods. The substantial corrective forces exert a high level of stress on the rods, and the ability of the rod to withstand these forces without undergoing permanent deformation relies on its biomechanical properties. These properties, in turn, are dependent on the material, diameter, and shape of the rod. The surgical treatment of AIS is characterized by the requirement for a special biomechanical profile that may differ substantially from what is needed for adult deformity surgery. This overview summarizes the current knowledge of rod biomechanics in frequently used rod constructs, with a particular focus on translational research between biomechanical studies and clinical applicability in AIS patients.

Spine rod straightening as a possible cause for revision

In a previous study, the authors examined the elastic and short-term anelastic springback of Ti6Al4V, CoCrMoC and A316L stainless steel spine rods to observe how the rods mechanically respond in OR contouring. In that study rods were 200 mm long and only the movement at the tip was recorded. The implication of that work was that rods will straighten in-vivo, however, in order for the mechanism of straightening to be determined, the movement of individual bends over time must first be elucidated. Spine rods used were, commercially pure titanium (CP Ti) a primarily α-phase; Ti-6Al-4V; α/β-phase titanium alloy from two different suppliers (denoted by, Ti-6Al-4V (L) and Ti-6Al-4V); β-phase titanium (TNTZ) and CoCrMoC. Following contouring the rods were aged unconstrained, in normal atmosphere or simulated body fluid (SBF) in a CO₂ incubator for up to 288 h. Elastic springback is significantly different between alloys with different microstructures. Both types of Ti6Al4V rods, while meeting the ASTM F136 industry standard, have significantly different properties, most importantly yield strength, flexural modulus, and springback. Environment showed no significant impact on anelasticity. The anelastic response of Ti6Al4V L sample, which has relatively more beta phase than the Ti6Al4V sample, follows the pure beta phase TNTZ in its extended time response. CoCrMoC and CP Ti have a very reduced anelastic response compared to the other alloys. This potentially can have unanticipated effects on the outcome of spine procedures, as the surgeon is reliant on the rods having similar properties to achieve a desired outcome.

An extension-distraction injury of the thoracic spine with traumatic partial correction of thoracic kyphosis

Study Design The study is a case report. Objective The authors aim to report an unusual injury pattern in a patient previously treated for thoracic kyphoscoliosis. Methods A postoperative (computed tomography) CT of a healthy 24-year-old man who underwent posterior instrumentation and fusion for a kyphoscoliosis deformity was compared with a CT performed after a motor vehicle accident (MVA) 1 year later, which resulted in an extension-distraction injury of T8 with no neurologic deficit. Cobb angles of the thoracic sagittal images of both CTs were measured using a digital measuring device and the values were recorded. Results Initial postoperative sagittal CT images demonstrate a 67-degree residual thoracic kyphosis compared with the post-MVA sagittal CT images, which reveal a 54-degree thoracic kyphosis, a 13-degree improvement in sagittal alignment. Conclusion It is unusual for a patient with long posterior instrumentation of the spine to sustain a spinal fracture without breakage of the rods, which were 6-mm nickel-titanium alloy with two crosslinks. Although sustaining plastic deformation, the rods maintained their integrity to the degree that the patient required no subsequent treatment to his spine at 12 months follow-up. It is rare to sustain a vertebral fracture without implant failure, which occurred in this case.

Rods in spinal surgery: a review of the literature

BACKGROUND CONTEXT

Spinal instrumentation has been used for more than five decades. Since the introduction of the Harrington rod in 1962, new rod materials and concepts have been developed. Rigid rod fixation has achieved higher fusion rates than previous methods. Recently, semirigid rod fixation devices have been used for both dynamic stabilization and fusion fixation. Memory rods, which have an interesting ability to return to their pre-bent shape when the temperature increases, are expected to be used for scoliosis correction.

PURPOSE

To review the previous literature regarding biofunctionality and biocompatibility of rods in spinal surgery.

CONCLUSION

The properties of each type of rod need to be taken into consideration when performing spinal instrumentation surgery.

Evaluation of spinal instrumentation rod bending characteristics for in-situ contouring

Bending characteristics were studied in rods used for spinal instrumentation at in-situ contouring conditions. Five groups of five 6 mm diameter rods made from: cobalt alloy (VITALLIUM), titanium-aluminum-vanadium alloy (SDI™), β-titanium alloy (TNTZ), cold worked stainless steel (STIFF), and annealed stainless steel (MALLEABLE) were studied. The bending procedure was similar to that typically applied for in-situ contouring in the operating room and included two bending cycles: first--bending to 21-24° under load with further release of loading for 10 min, and second--bending to 34-37° at the previously bent site and release of load for 10 min. Applied load, bending stiffness, and springback effect were studied. Statistical evaluation included ANOVA, correlation and regression analysis. TNTZ and SDI™ rods showed the highest (p < 0.05) springback at both bending cycles. VITALLIUM and STIFF rods showed mild springback (p < 0.05). The least (p < 0.05) springback was observed in the MALLEABLE rods. Springback significantly correlated with the bend angle under load (p < 0.001). To reach the necessary bend angle after unloading, over bending should be 37-40% of the required angle in TNTZ and SDI™ rods, 27-30% in VITALLIUM and STIFF rods, and around 20% in MALLEABLE rods.