Influence of Lumbar Lordosis on Posterior Rod Strain in Long-Segment Construct During Biomechanical Loading: A Cadaveric Study.

Objective: The lordotic shape of the lumbar spine differs substantially between individuals. Measuring and recording strain during spinal biomechanical tests is an effective method to infer stresses on spinal implants and predict failure mechanisms. The geometry of the spine may have a significant effect on the resultant force distribution, thereby directly affecting rod strain.

Methods: Seven fresh-frozen cadaveric specimens (T12-sacrum) underwent standard (7.5 Nm) nondestructive sagittal plane tests: flexion and extension. The conditions tested were intact and pedicle screws and rods (PSR) at L1-sacrum. The posterior right rod was instrumented with strain gauges between L3-4 (index level) and the L5-S1 pedicle screw. All specimens underwent lateral radiographs before testing. Lordotic angles encompassing different levels (L5-S1, L4-S1, L3-S1, L2-S1, and L1-S1) were measured and compared with rod strain. Data were analyzed using Pearson correlation analyses.

Results: Strong positive correlations were observed between lordosis and posterior rod strain across different conditions. The L3-S1 lordotic angle in the unloaded intact condition correlated with peak rod strain at L3-4 with PSR during flexion (R = 0.76, p = 0.04). The same angle in the unloaded PSR condition correlated with peak strain in the PSR condition during extension (R = -0.79, p = 0.04). The unloaded intact L2-S1 lordotic angle was significantly correlated with rod strain at L3-4 in the PSR condition during flexion (R = 0.85, p = 0.02) and extension (R = -0.85, p = 0.02) and with rod strain at L5-S1 in the PSR condition during flexion (R = 0.84, p = 0.04).

Conclusion: Lordosis measured on intact and instrumented conditions has strong positive correlations with posterior rod strain in cadaveric testing.