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Laser Marking of Spine Rods Is Strongly Associated With Risk of Clinical Rod Failure.

Reed Ayers1, Andriy Noschenko, David Ou-Yang

  • 1From the Department of Orthopedics, University of Colorado, School of Medicine, Aurora, CO.

The Journal of the American Academy of Orthopaedic Surgeons
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Summary

Manufacturing defects like laser markings on spinal rods significantly increase fracture risk. Patients with higher BMI and multi-level fusions using marked rods face a 40% higher chance of early rod fracture.

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Area of Science:

  • Spinal instrumentation analysis
  • Biomechanical engineering
  • Orthopedic implant failure

Background:

  • Spinal instrumentation failure, though infrequent, necessitates metallurgic analysis of removed hardware.
  • Manufacturing and design aspects of instrumentation are often overlooked causes of rod fracture.
  • This study uniquely analyzes rod characteristics like alloy, surface markings, and fracture type.

Purpose of the Study:

  • To investigate the relationship between spinal rod characteristics and fracture.
  • To identify manufacturing or design features that may initiate rod fracture.
  • To determine factors contributing to revision surgery due to hardware failure.

Main Methods:

  • Retrospective and prospective Institutional Review Board (IRB) study.
  • Inclusion of 56 patients (18-85 years) undergoing revision spine surgery (cervical, thoracic, lumbar).
  • Analysis of 101 removed spinal rods for fracture, surface markings, and metallurgic properties.

Main Results:

  • Laser marking was significantly associated with rod fracture (P < 0.0001).
  • Marking induced surface/subsurface changes (melting, cracking, notching) that initiate fractures.
  • Key predictors of rod fracture: body mass index, presence of laser mark, and posterior fusion length (>2 levels).

Conclusions:

  • Laser-marked rods in multi-level fusions (>2 levels) increase early rod fracture risk by 40% for a given body mass index.
  • Manufacturing processes, specifically laser marking, are critical factors in spinal rod longevity.
  • This highlights the need to consider implant design and manufacturing in preventing hardware failure.