Biomechanical Effects of Proximal Polyetheretherketone Rod Extension on the Upper Instrumented and Adjacent Levels in a Human Long-Segment Construct: A Cadaveric Model

Abstract

Objective: The high mechanical stress zone at the sudden transition from a rigid to flexible region is involved in proximal junctional kyphosis (PJK) physiopathology. We evaluated the biomechanical performance of polyetheretherketone (PEEK) rods used as a nontraditional long semirigid transition phase from a long-segment metallic rod construct to the nonfused thoracic spine.Methods: Pure moment range of motion (ROM) tests (7.5 Nm) were performed on 7 cadaveric spine segments followed by compression (200 N). Specimens were tested in the following conditions: (1) intact; (2) T10-pelvis pedicle screws and rods (PSRs); and (3) extending the proximal construct to T6 using PEEK rods (PSR+PEEK). T10–11 rod strain, T9 anterolateral bone strain, and T10 screw bending moments were analyzed.Results: At the upper instrumented vertebra (UIV)+1, PSR+PEEK versus PSR significantly decreased ROM in flexion (115%, p = 0.02), extension (104%, p = 0.003), left lateral bending (46%, p = 0.02), and right lateral bending (63%, p = 0.008). Also, at UIV+1, PSR+PEEK versus intact significantly decreased ROM in flexion (111%, p = 0.01) and extension (105%, p = 0.003). The UIV+1 anterior column bone strain was significantly reduced with PSR+PEEK versus PSR during right lateral bending (p = 0.02). Rod strain polarities reversed with PEEK rods in all loading directions except compression.Conclusion: Extending a long-segment construct using PEEK rods caused a decrease in adjacent-level hypermobility as a consequence of long-segment immobilization and also redistributed the strain on the UIV and adjacent levels, which might contribute to PJK physiopathology. Further studies are necessary to observe the clinical outcomes of this technique.