• Jessica A Tang, Jeremi M Leasure, Justin S Smith, Jenni M Buckley, Dimitriy Kondrashov, and Christopher P Ames.
• The Taylor Collaboration, San Francisco, California 94117, USA. jtang@taylorcollaboration.org
• Neurosurgery. 2013 Feb 1;72(2):276-82; discussion 283.

BackgroundRod failure has been reported clinically in pedicle subtraction osteotomy (PSO) to correct flat back deformity.ObjectiveTo characterize the fatigue life of posterior screw-rod constructs in the setting of PSO as a function of the severity of rod contour angle.MethodsA 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.ResultsAt 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).ConclusionResults 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.

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