Biomechanical evaluation of the hybrid pedicle screw—cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration—finite element analysis

BMC Musculoskeletal Disorders, 2023 · DOI: https://doi.org/10.1186/s12891-023-06411-z · Published: June 24, 2023

Simple Explanation

This study evaluates different surgical techniques for spinal fusion, specifically focusing on how these techniques affect the segments of the spine adjacent to the fusion site. The researchers used computer models to compare the biomechanical effects of different screw placements (pedicle vs. cortical) in transforaminal lumbar interbody fusion (TLIF). The goal was to find a technique that minimizes stress and degeneration in the adjacent segments after spinal fusion.

Study Duration

Not specified

Participants

Four human cadaveric lumbar spine specimens

Evidence Level

Not specified

Key Findings

1
Hybrid bilateral cortical screw - bilateral pedicle screw (CBT-PS) decreases the impact on adjacent segments after spinal fusion.
2
CBT-PS reduces the iatrogenic injury to the paravertebral tissues.
3
CBT-PS provides throughout decompression of the lateral recess.

Research Summary

This study used finite element analysis to compare the biomechanical effects of four different fixation techniques on adjacent segments after transforaminal lumbar interbody fusion (TLIF). The hybrid bilateral cortical screw - bilateral pedicle screw (CBT-PS) technique was found to decrease the impact on adjacent segments and reduce iatrogenic injury to paravertebral tissues. The CBT-PS technique also provides throughout decompression of the lateral recess, which is important for nerve root decompression.

Practical Implications

Surgical Technique Selection

The choice of fixation technique (PS-PS, CBT-CBT, PS-CBT, or CBT-PS) can influence the biomechanical environment of adjacent segments after TLIF.

Minimally Invasive Approach

CBT-PS offers advantages in terms of minimizing surgical incision, damage to the facet joint and paravertebral structures, and providing sufficient nerve decompression.

Balancing Stress

CBT-PS limits the upward movement of the spinal center allowing the caudal adjacent segment which was more stable to undertake more compensatory effects and avoiding the premature development of ASD.

Study Limitations

1
Insufficient sample size.
2
No comprehensive analysis of the effect of different sizes of screws on the experimental results.
3
The factors that affect the incidence of ASD were not only the choice of fixation techniques and surgical procedure but also the patient’s specific factors

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