Posterior spinal instrumentation: biomechanical study on the role of rods on hardware response to axial load

Posterior spinal instrumentation is frequently used for the treatment of spine disorders. Importantly, different requirements have to be considered for the optimal use of these systems in various clinical scenarios. In this work, we focused on the role of rods diameter on hardware's stiffness. For this purpose, we established an in vitro model and compared the response to axial load of a posterior stabilization system, characterized by rods of different diameter (4, 5, 6 mm), with that of Dynesys®. Intuitively, the higher the stiffness of the hardware, the lower the load is transferred to the disc. However, the 4 hardware tested showed a different trend in the response to the load regimens: when increasing the load, more flexible systems display a progressive reduction in the percentage of load which is transferred to the disc while more rigid system display the opposite trend. Considering that the load which is transferred, and not by-passed by the hardware, influences the healing of a fracture; the integration of a bone graft or a cage; the fusion process, these data have a relevant impact on clinical practice and highlight features that have to be considered in the choice for the optimal posterior spinal instrumentation.