Rod fracture and nonunion are common complications associated with pedicle subtraction osteotomies (PSO). Supplementary rods and interbody cage (IB) are added to reduce the primary rod stress. As supplementary rods, delta rods and cross rods have been proposed to reduce more stress on the primary rods compared to conventional supplementary rods (accessary rods) in PSO. The objective of this study is to investigate the effects of cross rods and delta rods on reducing primary rod stress in PSO subject. A validated 3D finite element model of a T12-S1 spine segment with 25° PSO at L3 and bilateral rods fixation from T12-S1 was used to compare different rod configurations: 1) PSO and two primary rods (PSO+2P); 2) PSO with an IB at L2-L3 (PSO+2P+IB); 3) PSO with accessory rods and an IB at L2-L3 (PSO+2P+IB+2A); 4) PSO with delta rods and an IB at L2-L3 (PSO+2P+IB+2D); 5) PSO with single cross rod and an IB at L2-L3 (PSO+2P+IB+1C); 6) PSO with double cross rods and an IB at L2-L3 (PSO+2P+IB+2C). The spine model was loaded with a follower load of 400 N combined with pure moments of 7.5 Nm in flexion, extension, right lateral bending, and right axial rotation. Von Mises stress of the primary rods were predicted for all test conditions. The PSO without IB condition had the largest primary rod stress in flexion. With IB at L2-L3, the rod stress in flexion reduced by 15%. Adding 2 conventional supplementary rods reduced the rod stress in flexion by 29%, which was achieved by adding single cross rod. The maximum von Mises stress occurred in the middle of the primary rods without supplementary rods whereas the maximum stress concentrated adjacent to the contact region between the connectors and the primary rods. Delta rods and double cross rods reduced the most rod stress in flexion, which were by 33% and 32% respectively. Under lateral bending, 2 delta rods reduced the most primary rod stress (−33%). Under axial rotation, the single cross rod reduced the most primary rod stress (−48%). Interbody cages and supplementary rods reduced the primary rod stress in a comparable way. Primary rod stress with 2 delta rods and double cross rods were comparable, which were marginally lower than those with conventional supplementary rods. Adding single cross rod was comparable to adding 2 conventional accessory rods in rod stress reduction in flexion. Under lateral bending, delta rods reduced most rod stress whereas under axial rotation, cross rods reduced most rod stress. This study suggested that both delta rods and cross rods reduce more primary rod stress than conventional accessory rods do.

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