Finite element study of the impact of pedicle screw density on the biomechanical response of a Lenke 1AN scoliotic curve.

Introduction: Benefits of increasing screw density in posterior instrumentation used to treat a scoliotic deformity are demonstrated using a three-dimensional finite element model (FEM) of the thoracolumbosacral spine. Methods: The FEM represents a Lenke 1AN scoliotic deformity with a 50° Cobb angle and 20° apical vertebral rotation. The curve is corrected with bilateral pedicle screw fixation and 75 separate randomized screw distributions. Results: Total construct screw density, concave rod screw locations at T6, T10, T11 and T12, and convex rod screw locations at T7 and T12 each correlate strongly with reductions in postoperative Cobb angle (P < 0.05). Apical vertebral rotation is greatly impacted (reduced) by screws placed at the apical vertebra on both concave and convex rods (P < 0.05). Under pure moment loading, intersegmental micromotion is generally reduced when motion segment screw density is increased, with the exception being the upper instrumented joint. Conclusions: These results suggest that increasing the screw density of posterior constructs used to treat a Lenke 1AN scoliotic deformity may improve the de-rotation correction with better postural restoration, reducing the risk of future complications including pseudarthrosis.