Dhar Utpal K, Aghayev Kamran, Sultan Hadi, Rajendran Saahas, Tsai Chi-Tay, Vrionis Frank D
Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA.
BHT Clinic, 34307 Istanbul, Türkiye.
Bioengineering (Basel). 2025 Jun 19;12(6):671. doi: 10.3390/bioengineering12060671.
The traditional bilateral pedicle screw system has been used for the treatment of various lumbar spine conditions including advanced degenerative disc disease. However, there is an ongoing need to develop more effective and less invasive techniques. The purpose of this study was to compare the traditional bilateral pedicle screw system (BPSS) with the novel reverse transdiscal screw system (RTSS) for lumbar disc degenerative disease. A 3D solid lumbar L1-L5 spine model was developed and validated based on a human CT scan. Fusions were simulated at L3-L4. The first scenario comprised a transforaminal lumbar interbody cage in combination with the bilateral pedicle screw-rod system (BPSS-TLIF). In the second scenario, the same TLIF cage was combined with reverse L3-L4 transdiscal screws (RTSS-TLIF). Testing parameters included range of motion (ROM) in three orthogonal axes, hardware (cage and screw) stress, and shear load resistance. The ROM of the surgical model was reduced by approximately 90% compared to the intact model at the fused level. The RTSS model demonstrated less ROM compared to the BPSS model at the fused level for all loading conditions. Overall, the RTSS model exhibited lower stress on both screws and cage compared with the BPSS model in all biomechanical testing conditions. The RTSS model also exhibited higher anterior and posterior shear load resistance than the BPSS model. In conclusion, the RTSS model proved superior to the BPSS model in all respects. These findings indicate that the RTSS could serve as a feasible option for patients undergoing lumbar fusion, especially for adjacent segment disease, potentially enhancing surgical outcomes for disc degeneration.
传统的双侧椎弓根螺钉系统已被用于治疗包括晚期退行性椎间盘疾病在内的各种腰椎疾病。然而，人们一直需要开发更有效且侵入性更小的技术。本研究的目的是比较传统的双侧椎弓根螺钉系统（BPSS）与新型经椎间盘反向螺钉系统（RTSS）治疗腰椎间盘退变疾病的效果。基于人体CT扫描建立并验证了一个三维实体L1-L5腰椎脊柱模型。在L3-L4节段模拟融合。第一种情况包括椎间融合器联合双侧椎弓根螺钉-棒系统（BPSS-TLIF）。在第二种情况中，相同的椎间融合器与L3-L4反向经椎间盘螺钉联合使用（RTSS-TLIF）。测试参数包括三个正交轴上的活动范围（ROM）、内固定器械（椎间融合器和螺钉）应力以及抗剪切载荷。与完整模型相比，手术模型在融合节段的ROM降低了约90%。在所有加载条件下，RTSS模型在融合节段的ROM均小于BPSS模型。总体而言，在所有生物力学测试条件下，RTSS模型的螺钉和椎间融合器上的应力均低于BPSS模型。RTSS模型的前后抗剪切载荷也高于BPSS模型。总之，RTSS模型在各方面均优于BPSS模型。这些发现表明，RTSS对于接受腰椎融合手术的患者，尤其是对于相邻节段疾病，可能是一种可行的选择，有望提高椎间盘退变的手术效果。
