Monolithic superelastic rods with variable flexural stiffness for spinal fusion: Simplified finite element analysis of an instrumented spine segment

Rigid instrumentations have been widely used for spinal fusion but they come with complications, such as adjacent disc degeneration. Dynamic instrumentations have been tested but their efficiency (stabilization capability) and reliability (mechanical integrity of the implant) have yet to be proven. A monolithic Ti-Ni spinal rod with variable flexural stiffness is proposed to reduce the risks associated with spinal fusion while maintaining adequate stabilization. This publication presents a simplified numerical model capable of evaluating the eventual benefits of a Ti-Ni spinal rod with variable flexural stiffness. Methods: A simplified instrumented spine segment model composed of six vertebrae and five discs has been developed. Two types of spinal rods were evaluated: Classic Ti instrumentation and Ti-Ni rods with variable stiffness. Both instrumentations were tested using two anchor configurations: pedicle screws only or a screws-cable combination. Findings and discussion: The all-screws configuration does not allow much motion with either classic Ti or variable Ti-Ni rods. The combination of a Ti rod with screws-cable anchoring allows more motion and, therefore, lower adjacent disk pressure, but puts extremely high stresses on the rod and anchors. The combination of the variable Ti-Ni rod and screws-cable anchoring leads to a significant decrease in adjacent disk pressure, without increasing stresses and pullout forces in the spinal instrumentation.