Hybrid Pedicle Screw and Modified Cortical Bone Trajectory Technique in Transforaminal Lumbar Interbody Fusion at L4-L5 Segment: Finite Element Analysis

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2023 Apr 13

PMID 37055739

Authors

Alafate Kahaer

Rui Zhang

Yixi Wang

Haopeng Luan

Abulikemu Maimaiti

Dongshan Liu

Wenjie Shi

Tao Zhang

Hailong Guo

Paerhati Rexiti

Affiliations

Soon will be listed here.

Abstract

Background: Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF).

Methods: Three finite element (FE) models of the L1-S1 lumbar spine were established according to the three human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 Nm moments in flexion, extension, bending, and rotation.

Results: BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS technique has the lowest ROM in flexion and lateral bending. The BMCS-BMCS technique showed maximal cage stress in flexion and lateral bending, and the BPS-BPS technique in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS technique, BPS-BMCS technique presented a lower risk of screw breakage and BMCS-BPS technique presented a lower risk of rod breakage.

Conclusion: The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.

Citing Articles

Biomechanical impact of cortical bone vs. traditional pedicle screw trajectories: a finite element study on lumbar spinal instrumentation.

Li X, Abdel-Latif K, Schwab J, Zhou X, Yang J, Ritter Z Front Bioeng Biotechnol. 2025; 13:1541114.

PMID: 40041103 PMC: 11876142. DOI: 10.3389/fbioe.2025.1541114.

Biomechanical properties analysis of posterior lumbar interbody fusion with transpedicular oblique screw fixation.

Wu L, Jiang X, Guan T, He Z, Li J Heliyon. 2024; 10(19):e38929.

PMID: 39435082 PMC: 11491909. DOI: 10.1016/j.heliyon.2024.e38929.

Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases.

Ding Y, Zhang H, Jiang Q, Li T, Liu J, Lu Z Front Bioeng Biotechnol. 2024; 12:1393005.

PMID: 38903190 PMC: 11186988. DOI: 10.3389/fbioe.2024.1393005.

Comparative Biomechanical Stability of the Fixation of Different Miniplates in Restorative Laminoplasty after Laminectomy: A Finite Element Study.

Liu G, Huang W, Leng N, He P, Li X, Lin M Bioengineering (Basel). 2024; 11(5).

PMID: 38790385 PMC: 11117612. DOI: 10.3390/bioengineering11050519.

Hybrid cortical bone trajectory and modified cortical bone trajectory techniques in transforaminal lumbar interbody fusion at L4-L5 segment: A finite element analysis.

Wang Y, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maitusong M Heliyon. 2024; 10(5):e26294.

PMID: 38434416 PMC: 10906328. DOI: 10.1016/j.heliyon.2024.e26294.

References

Kim J, Park S, Lee Y, Nam T, Park Y, Kim Y . The Effects of Spinopelvic Parameters and Paraspinal Muscle Degeneration on S1 Screw Loosening. J Korean Neurosurg Soc. 2015; 58(4):357-62. PMC: 4651997. DOI: 10.3340/jkns.2015.58.4.357. View

Shim C, Park S, Lee S, Lim T, Chun K, Kim D . Biomechanical evaluation of an interspinous stabilizing device, Locker. Spine (Phila Pa 1976). 2008; 33(22):E820-7. DOI: 10.1097/BRS.0b013e3181894fb1. View

Natarajan R, Watanabe K, Hasegawa K . Biomechanical Analysis of a Long-Segment Fusion in a Lumbar Spine-A Finite Element Model Study. J Biomech Eng. 2018; 140(9). DOI: 10.1115/1.4039989. View

Rexiti P, Aierken G, Wang S, Abudurexiti T, Abuduwali N, Deng Q . Anatomical research on strength of screw track fixation in novel cortical bone trajectory for osteoporosis lumbar spine. Am J Transl Res. 2019; 11(11):6850-6859. PMC: 6895526. View

Verma K, Boniello A, Rihn J . Emerging Techniques for Posterior Fixation of the Lumbar Spine. J Am Acad Orthop Surg. 2016; 24(6):357-64. DOI: 10.5435/JAAOS-D-14-00378. View

Matsukawa K, Yato Y, Nemoto O, Imabayashi H, Asazuma T, Nemoto K . Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography. J Spinal Disord Tech. 2013; 26(6):E248-53. DOI: 10.1097/BSD.0b013e318288ac39. View

Deyo R, Mirza S, Martin B, Kreuter W, Goodman D, Jarvik J . Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010; 303(13):1259-65. PMC: 2885954. DOI: 10.1001/jama.2010.338. View

Kahaer A, Maimaiti X, Maitirouzi J, Wang S, Shi W, Abuduwaili N . Biomechanical investigation of the hybrid modified cortical bone screw-pedicle screw fixation technique: Finite-element analysis. Front Surg. 2022; 9:911742. PMC: 9339714. DOI: 10.3389/fsurg.2022.911742. View

de Kunder S, van Kuijk S, Rijkers K, Caelers I, van Hemert W, de Bie R . Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J. 2017; 17(11):1712-1721. DOI: 10.1016/j.spinee.2017.06.018. View

10.

Santoni B, Hynes R, McGilvray K, Rodriguez-Canessa G, LYONS A, Henson M . Cortical bone trajectory for lumbar pedicle screws. Spine J. 2008; 9(5):366-73. DOI: 10.1016/j.spinee.2008.07.008. View

11.

Xu H, Ju W, Xu N, Zhang X, Zhu X, Zhu L . Biomechanical comparison of transforaminal lumbar interbody fusion with 1 or 2 cages by finite-element analysis. Neurosurgery. 2013; 73(2 Suppl Operative):ons198-205. DOI: 10.1227/01.neu.0000430320.39870.f7. View

12.

Lee G, Ahn M . Comparative Study of Cortical Bone Trajectory-Pedicle Screw (Cortical Screw) Versus Conventional Pedicle Screw in Single-Level Posterior Lumbar Interbody Fusion: A 2-Year Post Hoc Analysis from Prospectively Randomized Data. World Neurosurg. 2017; 109:e194-e202. DOI: 10.1016/j.wneu.2017.09.137. View

13.

Perez-Orribo L, Kalb S, Reyes P, Chang S, Crawford N . Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. Spine (Phila Pa 1976). 2012; 38(8):635-41. DOI: 10.1097/BRS.0b013e318279a95e. View

14.

Rexiti P, Aierken A, Sadeer A, Wang S, Abuduwali N, Deng Q . Anatomy and Imaging Studies on Cortical Bone Screw Freehand Placement Applying Anatomical Targeting Technology. Orthop Surg. 2020; 12(6):1954-1962. PMC: 7767784. DOI: 10.1111/os.12775. View

15.

Ohkawa T, Iwatsuki K, Ohnishi Y, Ninomiya K, Yoshimine T . Isthmus-guided Cortical Bone Trajectory Reduces Postoperative Increases in Serum Creatinine Phosphokinase Concentrations. Orthop Surg. 2015; 7(3):232-8. PMC: 6583754. DOI: 10.1111/os.12189. View

16.

Huang Z, Nie M, Zhang N, Liu S, Yuan J, Lin X . Biomechanical evaluation of a short-rod technique for lumbar fixation surgery. Front Bioeng Biotechnol. 2022; 10:959210. PMC: 9403742. DOI: 10.3389/fbioe.2022.959210. View

17.

Matsukawa K, Yato Y, Imabayashi H, Hosogane N, Asazuma T, Nemoto K . Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study. J Neurosurg Spine. 2015; 23(4):471-8. DOI: 10.3171/2015.1.SPINE141103. View

18.

Fujiwara S, Ohnishi Y, Iwatsuki K, Kishima H . Cortical bone trajectory fixation cause low compression force in anterior vertebral column. N Am Spine Soc J. 2022; 10:100113. PMC: 9005947. DOI: 10.1016/j.xnsj.2022.100113. View

19.

Ayturk U, Puttlitz C . Parametric convergence sensitivity and validation of a finite element model of the human lumbar spine. Comput Methods Biomech Biomed Engin. 2011; 14(8):695-705. DOI: 10.1080/10255842.2010.493517. View

20.

Xiao X, Chen G, Wang S, Liu J, Lin E, Chen K . Efficacy of the Dynesys Hybrid Surgery for Patients with Multi-Segmental Lumbar Spinal Stenosis. Front Surg. 2022; 9:849679. PMC: 9195297. DOI: 10.3389/fsurg.2022.849679. View