High-Demand Spinal Deformity With Multi-Rod Constructs and Porous Fusion/Fixation Implants: A Finite Element Study

Matteo Panico, Ruchi D. Chande, Derek P. Lindsey, Tomaso Maria Tobia Villa, Scott A. Yerby, Marco Brayda-Bruno, Tito Bassani, David W. Polly, Fabio Galbusera

Research output: Contribution to journalArticlepeer-review


Study Design: Basic science (finite element analysis). Objectives: Pedicle subtraction osteotomy (PSO) at L5 is an effective treatment for sagittal imbalance, especially in select cases of patients showing kyphosis with the apex at L4-L5 but has been scarcely investigated. The aim of this study was to simulate various “high-demand” instrumentation approaches, including varying numbers of rods and sacropelvic implants, for the stabilization of a PSO at L5. Methods: A finite element model of T10-pelvis was modified to simulate posterior fixation with pedicle screws and rods from T10 to S1, alone or in combination with an L5 PSO. Five additional configurations were then created by employing rods and novel porous fusion/fixation implants across the sacroiliac joints, in varying numbers. All models were loaded using pure moments of 7.5 Nm in flexion-extension, lateral bending, and axial rotation. Results: The osteotomy resulted in a general increase in motion and stresses in posterior rods and S1 pedicle screws. When the number of rods was varied, three- and four-rod configurations were effective in limiting the maximal rod stresses; values approached those of posterior fixation with no osteotomy. Maximum stresses in the accessory rods were similar to or less than those observed in the primary rods. Multiple sacropelvic implants were effective in reducing range of motion, particularly of the SIJ. Conclusions: Multi-rod constructs and sacropelvic fixation generally reduced maximal implant stresses and motion in comparison with standard posterior fixation, suggesting a reduced risk of rod breakage and increased joint stability, respectively, when a high-demand construct is utilized for the correction of sagittal imbalance.

Original languageEnglish (US)
JournalGlobal Spine Journal
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
The study was partially supported by the Italian Ministry of Health (Ricerca Corrente). The authors would like to thank Mr Francois Follini for providing a 3D model of the porous fusion/fixation implant for use in this FEA study.

Publisher Copyright:
© The Author(s) 2022.


  • biomechanics
  • finite element
  • high-demand construct
  • L5
  • multi-rod
  • pedicle subtraction osteotomy

PubMed: MeSH publication types

  • Journal Article


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