Chinese Journal of Tissue Engineering Research ›› 2026, Vol. 30 ›› Issue (3): 586-595.doi: 10.12307/2025.865

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Effects of three internal fixation techniques on biomechanics of adjacent segment degeneration in lumbar interbody fusion

Abudusalamu·Tuoheti1, 2, Xiao Yang1, Wang Yixi1, Musitapa·Mijiti3, Chen Qihao1, Maimaitiming·Saiyiti4, Guo Hailong1, Paerhati·Rexiti1, 5   

  1. 1Department of Minimally Invasive Spine Surgery and Precision Orthopedics, 3Department of Rehabilitation Medicine, 4Department of Microreconstructive Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China; 2Department of Spine and Traumatology, The Second People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830002, Xinjiang Uygur Autonomous Region, China; 5Key Laboratory of High Incidence Diseases Research of Ministry of Education (Xinjiang Medical University), Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Received:2024-07-22 Accepted:2024-11-20 Online:2026-01-28 Published:2025-07-03
  • Contact: Paerhati·Rexiti, Chief physician, Professor, Doctoral and master’s supervisor, Department of Minimally Invasive Spine Surgery and Precision Orthopedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China; Key Laboratory of High Incidence Diseases Research of Ministry of Education (Xinjiang Medical University), Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Abudusalamu•Tuoheti, Master candidate, Department of Minimally Invasive Spine Surgery and Precision Orthopedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China; Department of Spine and Traumatology, The Second People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • Supported by:
    Outstanding Youth Science Fund of Xinjiang Uygur Autonomous Region, No. 2021D01E29 (to PR); “Tianshan Talents” Medical and Health High-level Talent Training Program Fund, No. TSYC202301B026 (to PR); Graduate Innovation Project Fund of Xinjiang Uygur Autonomous Region, No. XJ2024G158 (to AT)

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Abstract: BACKGROUND: In 2019, the modified cortical bone trajectory technique was proposed by our team, significantly improving traditional methods. Previous studies have highlighted its superior biomechanical properties for segment fixation. However, a comprehensive systematic analysis of its specific biomechanical effects on adjacent segment degeneration is lacking, particularly regarding its influence on range of motion and intervertebral disc stress in posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques.
OBJECTIVE: To investigate the biomechanical effects of modified cortical bone trajectory screw techniques on adjacent segment degeneration in posterior lumbar interbody fusion and transforaminal lumbar interbody fusion.
METHODS: CT scans were performed on three human cadaver specimens to establish and validate three-dimensional intact finite element models of the L1-S1 segment. For each of these, the posterior lumbar interbody fusion or transforaminal lumbar interbody fusion with three different fixation techniques was reconstructed at the L4-L5 segment. The L4-L5 segment was fixed using three different internal fixation techniques (modified cortical bone trajectory, cortical bone trajectory, and traditional pedicle screws). The range of motion and von Mises stress of the intervertebral disc of the L3-L4 and L5-S1 segments were recorded with a 400 N compressive load and 7.5 N moments in flexion, extension, left-right bending, and left-right rotation. The impacts of the three internal fixation techniques on adjacent segment degeneration in the two kinds of fusion were compared and analyzed. 
RESULTS AND CONCLUSION: (1) In the posterior lumbar interbody fusion model, the modified cortical bone trajectory screw group showed a reduced range of motion on adjacent segments (L3-L4, L5-S1) under six loading conditions compared to both the cortical bone trajectory screw group and traditional bone trajectory screw group. Specifically, the modified cortical bone trajectory screw group significantly reduced the maximum stress on the intervertebral disc in the superior adjacent segment (L3-L4) during extension compared to the traditional bone trajectory screw group (P=0.005), while the stress on the intervertebral disc in the inferior adjacent segment (L5-S1) exhibited greater dispersion. Similarly, the cortical bone trajectory screw group also significantly reduced the maximum stress on the intervertebral disc in the superior adjacent segment (L3-L4) during extension compared with the traditional bone trajectory screw group (P=0.03). (2) Compared with transforaminal lumbar interbody fusion, the three internal fixation techniques (modified cortical bone trajectory, cortical bone trajectory, and traditional pedicle screws) showed a trend of reduced range of motion in the inferior adjacent segment (L5-S1) under six loading conditions. In contrast, the maximum stress on the intervertebral discs in both the superior and inferior adjacent segments (L3-L4, L5-S1) exhibited an increasing trend in the posterior lumbar interbody fusion model. (3) It is concluded that in the posterior lumbar interbody fusion model, the modified cortical bone trajectory screw exhibited superior biomechanical properties in reducing the range of motion at adjacent segments, which may have a beneficial effect on reducing the risk of adjacent segment degeneration.

Key words: lumbar fusion, adjacent segment degeneration, cortical bone trajectory, finite element analysis, biomechanics, digital medicine

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