Background: Paediatric spinal systems made from stainless steel are effective at correcting early onset scoliosis in a non-fusion technique. The use of similar systems manufactured from titanium is an attractive alternative as it would allow Magnetic Resonance Imaging of the patient with its recognised imaging advantages.

Objective: We performed a prospective in vitro study to compare the mechanical performance of a current clinically used stainless steel construct with an identical proposed titanium alternative.

Methods: Twelve spinal constructs of each material were constructed in a typical in vivo configuration using a corpectomy model in accordance with ASTM F1798 standard. Five samples for each metal were subjected to axial compressive static loading at a rate of 1mm/s until plastically deformed. Seven samples for each metal were then subject to varying compressive cyclic loads until a 5 million cycle run out was observed. From this data a fatigue S-N curve was generated.

Results: The stiffness of each construct was then calculated and the results were statistically analysed. For steel and titanium we calculated 95% confidence intervals of 23.9 to 35.7 and 18.8 to 23.7 respectfully. Significance P(< 0.05). The fatigue strength to 5 million cycles was 179N and 150N for steel and titanium respectfully. Failure occured most commonly in the rods close to the transverse rod connector or the pedicle screw / polyethylene block interface.

Conclusions: We conclude that with identical dimensions, the stainless steel constructs had a significantly higher Modulus of Elasticity than titanium. The fatigue strength for steel was also higher than titanium. The potential use of titanium as an alternative to stainless steel in paediatric spinal systems is still an attractive alternative. Given the results, we would suggest that further re-designing and testing be carried out before clinical release and then initially be reserved for selected patients with lower body weight or physical demands.