Study design: An in vitro cadaveric study to compare compressive failure load, strength, and stiffness of the implant-vertebra interface.
Objectives: To determine the effect of cage shape (kidney, cloverleaf, or oval) and cage surface area on endplate failure strength and secondly to determine the extent and pattern of trabecular failure adjacent to an interbody device.
Summary of background data: Recent studies indicate that the posterolateral and peripheral regions of the endplate are stronger than the central. Current implants are not designed to take advantage of these stronger regions of the endplate. The zone of trabecular failure that results from interbody device subsidence has not been reported extensively in the literature.
Methods: Uniaxial compression testing with unrestricted rotation was carried out on the superior endplates of 48 thoracolumbar (T9-L2) vertebrae with 1 of 3 shaped indentors covering 20% or 40% of the endplate area. Failure load, failure strength, and stiffness were compared. Quantitative computed tomography scans were carried out before and following indentation tests to identify areas of trabecular densification that indicate localized failure.
Results: The cloverleaf-shaped indentors resulted in significantly higher (P < 0.001) failure loads (by >45%), strength (>49%), and construct stiffness (>35%) for both the 20% and 40% cross-sectional area sizes. Trabecular bone failure occurred in a semielliptical zone underlying the interbody devices, leaving the endplate and underlying cancellous bone intact.
Conclusions: The cloverleaf-shaped indentor displayed an improved strength and stiffness profile when compared to oval or kidney-shaped indentors of similar surface areas.