Finite Element Analysis of Biomechanical Assessment: Traditional Bilateral Pedicle Screw System vs. Novel Reverse Transdiscal Screw System for Lumbar Degenerative Disc Disease.

Abstract

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.