Study design: Load sharing in stabilized spinal segments was evaluated using sequential injury and stabilization with a posterior instrumentation system under an in vitro flexibility protocol.
Objective: To analyze the partitioning of applied loads between anatomic and implanted structures of lumbar functional spinal units stabilized with a posterior instrumentation system. To identify surgical indications for which the risk of fixator breakage in vivo is high.
Summary of background data: Relatively few groups have experimentally measured the in vitro and in vivo forces and/or moments supported by posterior instrumentation systems, and no analysis, of the load sharing in these systems has been performed. This information will provide novel insight into implant fatigue life, and the degree to which the spinal anatomy is shielded from the applied load and will allow the verification of mathematical models for new injury scenarios.
Methods: Specimen kinematics were determined using an optoelectronic tracking system. Intradiscal pressure and the forces and moments supported by the implants were measured using, respectively, a needle-mounted pressure sensor and strain gauges mounted on the spinal implants.
Results: A large majority of the applied moments were supported by an equal and opposite force pair between the intervertebral disc and fixator rods in flexion and extension and an equal and opposite force pair between the left and right fixator rods in lateral bending. Torsional moments were shared approximately equally between the posterior elements, intervertebral disc, an equal and opposite shear force pair in the transverse plane between the right and left fixators and internal fixator moments.
Conclusions: When posterior instrumentation devices are used to stabilize severe anterior column injuries, they are at risk of fracture secondary to reversed bending moments.