Construct Rigidity after Fatigue Loading in Pedicle Subtraction Osteotomy with or without Adjacent Interbody Structural Cages

Introduction Studies document rod fracture in pedicle subtraction osteotomy (PSO) settings where disk spaces were preserved above or adjacent to the PSO. This study compares the multidirectional bending rigidity and fatigue life of PSO segments with or without interbody support. Methods Twelve specimens received bilateral T12-S1 posterior fixation and L3 PSO. Six received extreme lateral interbody fusion (XLIF) cages in addition to PSO at L2-L3 and L3-L4; six had PSO only. Flexion-extension, lateral bending, and axial rotation (AR) tests were conducted up to 7.5 Newton-meters (Nm) for groups: (1) posterior fixation, (2) L3 PSO, (3) addition of cages (six specimens). Relative motion across the osteotomy (L2-L4) and entire fixation site (T12-S1) was measured. All specimens were then fatigue tested for 35K cycles. Results Regardingmultiaxial bending, there was a significant 25.7% reduction in AR range of motion across L2-L4 following addition of cages. Regarding fatigue bending, dynamic stiffness, though not significant (p = 0.095), was 22.2% greater in the PSO + XLIF group than in the PSO-only group. Conclusions Results suggest that placement of interbody cages in PSO settings has a potential stabilizing effect, which is modestly evident in the acute setting. Inserting cages in a second-stage surgery remains a viable option and may benefit patients in terms of recovery but additional clinical studies are necessary to confirm this.