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Influence of Rod Contouring on Rod Strength and Stiffness in Spine Surgery

Article  in  Orthopedics · June 2015

DOI: 10.3928/01477447-20150603-61 · Source: PubMed

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n Feature Article

Influence of Rod Contouring on Rod

Strength and Stiffness in Spine Surgery
Satoru Demura, MD; Hideki Murakami, MD; Hiroyuki Hayashi, MD; Satoshi Kato, MD;
Katsuhito Yoshioka, MD; Noriaki Yokogawa, MD; Takayoshi Ishii, MD; Takashi Igarashi, MD;
Xiang Fang, MD; Hiroyuki Tsuchiya, MD

abstract

For spinal fusion or the correction of spine deformity at multiple levels, intraopera-
tive rod contouring is required to realign the spine. A French bender is the most com-
mon contouring tool used. There are several reports on the mechanical properties
of various rods with manufactured straight rod; however, few reports describe the
changes in a rod’s mechanical properties after rod contouring. The authors investi-
gated the influences of rod contouring on rod strength and stiffness. A 3-point bend-
ing test was conducted. Each 18-cm rod was loaded at a rate of 10 mm/min with a
load applicator. Three different rod diameters (5.5, 6.0, and 6.35 mm) and 2 types
of materials (titanium [Ti] alloy and cobalt-chromium [CoCr] alloy) were assessed.
Different rod curvatures were evaluated: (1) a no-preparation rod of 0° (control); (2)
a 0° rod bent at one point to make tangential angles of 10° and then bent back from
the opposite side; (3) a bent rod with tangential angles of 20°; and (4) a 40° bent
rod. The yield strength in all types of rod materials and diameter decreased after rod
contouring using a French bender. The extent of decrease depended on the degree
of bend. The bending stiffness of each rod also decreased. The CoCr rod showed
higher bending stiffness than the Ti rod of the same diameter. Rod contouring using a
French bender reduced the yield strength and stiffness in all types of rods. Decrease
of yield strength correlated to the degree of bend. In the comparison of 20° and
40° contoured rods, the 6.0-mm CoCr rod showed the highest reduction force. This
study found that rod contouring procedures reduced rod yield strength and stiffness.
[Orthopedics. 2015; 38(6):e520-e523.]

The authors are from the Department of Orthopaedic Surgery, School of Medicine, Kanazawa Uni-
versity, Kanazawa, Japan.
The authors have no relevant financial relationships to disclose.
Rod materials for this study were provided by Stryker Japan K.K.
Correspondence should be addressed to: Satoru Demura, MD, Department of Orthopaedic Surgery,
School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan 920-8641 (demudon@
med.kanazawa-u.ac.jp).
Received: April 21, 2014; Accepted: August 26, 2014.
doi: 10.3928/01477447-20150603-61

e520 Copyright © SLACK Incorporated

 n Feature Article

O
ne of the goals of spinal deformity
treatment is to maximize coronal
and axial plane correction while
restoring thoracic kyphosis. In recent years,
excellent 3-dimensional correction of spi-
nal deformities has been accomplished
using a combination of modern strategies,
such as direct vertebral rotation, multilevel
osteotomies, differential rod contour, and
the use of uniplanar screws.1-5 Currently, Figure 1: A French bender, which is the most com- Figure 2: Three-point bending setup with a bent
various rod materials and spinal rod diam- monly used contouring tool, was used to make the rod placed on the supporting rolls, separated by
contoured rods. 120 mm.
eters are available; therefore, it is crucial
to understand the mechanical properties
of the rods. This is especially important
because correction loss of the coronal or
sagittal plane is occasionally experienced
because the contoured rod is bent back dur-
ing the correction procedure.
Intraoperative rod contouring is usu-
ally required to realign the spine. A French
bender is a commonly used contouring A B
tool. There have been several reports on
the mechanical properties of various rods;
however, few reports describe the changes
in a rod’s mechanical properties after rod
contouring.6-8 The purpose of the current
study is to examine the influences of rod
contouring on rod strength and stiffness.
C D
Materials and Methods Figure 3: Load vs total displacement curve of 6.0-mm titanium alloy rod (A), 6.0-mm cobalt-chromium
alloy rod (B), 5.5-mm titanium alloy rod (C), and 6.35-mm titanium alloy rod (D).
Spinal rods manufactured with
5.5-, 6.0-, and 6.35-mm titanium (Ti)
alloy and 6.0-mm cobalt-chromium vs total displacement curve was recorded the yield strength and bending stiffness
(CoCr) alloy were assessed. All rods for each test and used for determining for all types of rod materials and diam-
were cut to a length of 180 mm. Differ- mechanical properties. Bending stiffness eters. The yield strength and bending
ent rod curvatures were evaluated: (1) a (N/mm) was determined by fitting the stiffness of the 6.0-mm Ti rod (0°, con-
no-preparation rod of 0° (control); (2) slope of the initial linear portion. Yield trol) were 1004.8±16.1 N and 160.3±1.9
a 0° rod bent at one point to make tan- strength (N) was determined by the point N/mm, respectively. After rod contouring
gential angles of 10° and then bent back of intersection between a load vs total with a French bender, the yield strength
from the opposite side; (3) a bent rod displacement curve and a line parallel showed a decrease depending on the
with tangential angles of 20°; and (4) a to the linear portion. Data are expressed degree of bend: 74.5% (0° bend back;
40° bent rod. All rods were contoured as mean±SD. For comparison between P=.28), 54.1% (20°; P=.04), and 50.6%
using a French bender (Figure 1). the groups, a one-way analysis of vari- (40°; P=.03). Bending stiffness also de-
A 3-point bending test was conducted. ance was used, followed by Dunnett’s or creased after rod contouring: 94.6% (0°
The rods were placed on 2 rolls sepa- Scheffe’s test. A P value less than .05 was bend back; P=.57), 89.2% (20°; P=.12),
rated by 120 mm. For each rod, the test considered statistically significant. and 74.9% (40°; P<.01). The bending
was accomplished at a constant displace- stiffness of the 6.0-mm CoCr rod was
ment rate of 10 mm/min with a load ap- Results higher than that of the Ti rod with the
plicator (Tensilon RTC-2410; Orientec All load vs total displacement curves same diameter on each bend. Meanwhile,
Co, Saitama, Japan) (Figure 2). A load are shown in Figure 3. The Table shows the yield strength of the 6.0-mm Ti rod

JUNE 2015 | Volume 38 • Number 6 e521

n Feature Article

Discussion
Table Currently, various rod materials are
available for spine surgery, including
Bending Stiffness and Yield Strength of Each Rod
Ti, CoCr, commercially pure titanium
Curvature, Mean±SD
(CPTi), stainless steel (SS), and ultra-
Variable 0° (Control) 0° (Bend Back)a 20°a 40°a strength stainless steel (UHSS). Studies
Stiffness, N/mm have described the biomechanical charac-
6.35-mm Ti 192.6±0.96 184.8±12.1 178.9±14.2 141.0±25.4 terization of spinal rods with no prepara-
(95.9%) (92.8%) (73.4%)
tion from the manufacturer. The mechani-
6.0-mm CoCr 317.0±6.65 278.6±43.6 261.1±3.69 208.7±18.8 cal properties of the rods are related to the
(87.8%) (82.3%)b (65.8%)b
rod material, diameter, and manufactur-
6.0-mm Ti 160.3±1.86 151.7±4.41 143.0±1.03 120.1±15.0
(94.6%) (89.2%) (74.9%)b ing process. In general, Ti and CPTi have
higher yield strength and lower Young’s
5.5-mm Ti 102.2±7.01 100.0±3.22 109.8±6.28 87.0±9.06
(97.8%) (106%) (85.1%) modulus than SS and CoCr.6 Serhan et al7
Yield strength, N analyzed the material properties of 4 dif-
6.35-mm Ti 1253±2.80 1045±395 650.4±251 698.1±235
ferent 5.5-mm rod materials and reported
(83.3%) (51.8%) (55.7%) that 5.5-mm CoCr and UHSS rods had the
6.0-mm CoCr 865±49.4 689.8±210 488.9±48.1 476.0±65.7 ability to produce higher correction forces
(79.6%) (56.4%)b (55.0%)b than Ti and SS rods.
6.0-mm Ti 1004±16.1 748.7±248 544.5±128 509.7±245 Meanwhile, there is minimal literature
(74.5%) (54.1%)b (50.6%)b evaluating the changes in a rod’s mechani-
5.5-mm Ti 803.9±36.7 757.6±65.6 324.0±7.24 375.1±70.9 cal properties after rod contouring with a
(94.2%) (40.3%)b (46.6%)
French bender. Lindsay et al8 evaluated
Abbreviations: CoCr, cobalt-chromium; Ti, titanium. fatigue strength after rod contouring with
a
Numbers in parentheses are percentage of the control.
b
P<.05. a French bender and reported that rod
contouring procedures significantly re-
duced the fatigue strength of Ti and CPTi
rods. Slivka et al9 evaluated the fatigue
strength of a 4.5-mm rod contoured with
tube benders and reported that the endur-
ance limits of all types of materials were
reduced between 20% and 40% in the bent
condition. However, neither study men-
tioned the yield strength and stiffness of
the contoured rods. In the current study,
A B
the yield strength and bending stiffness
Figure 4: Load vs total displacement curve of each 20° rod (A) and each 40° rod (B). Abbreviations: CoCr, decreased after rod contouring. Dick and
cobalt-chromium; Ti, titanium. Bourgeault10 analyzed a surface notch in-
duced by a French bender under a scanning
electron microscope and demonstrated the
was higher than that of the 6.0-mm CoCr er load: 1054.3±68.8 N (6.0-mm CoCr), indentation of the surface and fissures or
rod. The yield strength and bending stiff- 915.6±21.2 N (6.35-mm Ti), 748.7±34.2 cracks along the end of the notch in Ti and
ness of the 5.5- and 6.35-mm Ti rods also N (6.0-mm Ti), and 553.0±31.7 N (5.5- CPTi materials. In this study, there was
decreased after rod contouring. mm Ti) (Figure 4A). For the simulation of also a trend that the extent of decrease in
The load vs total displacement curve of an approximate rod reduction from 40° to yield strength and bending stiffness was
20° and 40° on each rod are shown in Fig- 20° (5-mm displacement), the load of each related to the degree of bend. The results
ure 4. When the displacement of the 20° rod was as follows: 809.5±23.5 N (6.0- indicate that both notches of the rods
bent rods was 6 mm, simulating an approx- mm CoCr), 674.9±32.1 N (6.35-mm Ti), and geometric effects of the angle influ-
imate rod reduction from 20° to 0°, the 6.0- 552.9±18.5 N (6.0-mm Ti), and 400.6±6.3 ence the mechanical property of the rod.
mm CoCr rod showed a significantly high- N (5.5-mm Ti) (Figure 4B). Clinically, rod contouring is inevitable in

e522 Copyright © SLACK Incorporated


spinal deformity surgery; however, it may
be beneficial to develop various degrees
of precontoured rods without surface ir-
regularities.
In the current study’s comparison of
load vs total displacement curve, the 6.0-
mm CoCr rod showed the highest reduc-
tion force, both in 20° and 40°. The bend-
ing stiffness of the 6.0-mm CoCr rod was
higher than that of the other rods. Even
after rod contouring, the CoCr rod had the
ability to withstand high acute corrective
forces with small amounts of rod defor-
mation. However, the results should be
interpreted with some caution. One of the
limitations of this study is that the spring-
back phenomenon has not been studied.
Serhan et al7 reported that CoCr rods had
the highest potential for plastic deforma-
tion in a highly rigid spine. Noshchenko
et al6 demonstrated that ß-titanium alloy
and titanium-aluminum-vanadium alloy
rods showed the highest springback at
rod-bending cycles and that CoCr and SS
rods showed mild springback.
The current study evaluated the in-
fluence of rod contouring with a French
bender on rod strength and stiffness.
However, the authors did not analyze the
mechanical properties when additional
implants (cross-links, multilevel pedicle
screws) were attached, which is a limita-
tion of this study. It has been reported that
the number of anchor points using mul-
JUNE 2015 | Volume 38 • Number 6
View publication stats
tiple hooks11 and rod length between the
points affect rod properties. Thus, a bio-
mechanical study with multiple screws is
warranted. Furthermore, an investigation
using a cadaver or a finite element model
may get more detailed information in a
clinical setting.
Conclusion
Rod contouring using a French bender
reduced yield strength and stiffness in
all types of rods. The extent of decrease
in yield strength and bending stiffness
was related to the degree of bend. In the
comparisons of 20° and 40° contoured
rods, the 6.0-mm CoCr rod showed the
highest reduction force. These results of-
fer a better understanding of mechanical
properties after rod contouring and may
influence the selection of rod material and
diameter.
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