The Anterolateral Transpedicular Transverse Process Screw Technique: Surgical Techniques, Biomechanical study and...

Area of Science:

• Spine surgery
• Orthopedic biomechanics
• Minimally invasive spinal fusion

Background:

• Current oblique lateral lumbar interbody fusion (OLIF) techniques face limitations including prolonged operation times, significant blood loss, and soft tissue damage.
• There is a need for improved internal fixation methods in OLIF to enhance safety and efficacy.

Purpose of the Study:

• To evaluate the feasibility, preliminary effectiveness, and biomechanical properties of a modified Anterolateral Transpedicular Transverse Process Screw (ALTTS) technique for lumbar interbody fusion.
• To compare the biomechanical performance of the ALTTS construct with other fixation methods.

Main Methods:

• CT-based simulations were used to assess ALTTS screw placement success rates in 40 patients (L1-L5).
• Finite element analysis compared three OLIF constructs (ALTTS + BALS, ASF, BPSF) for range of motion and stress distribution under varying bone densities.
• Clinical outcomes of 12 patients treated with OLIF using L5 ALTTS and L4 BALS fixation were assessed using VAS and ODI scores.

Main Results:

• ALTTS demonstrated a high placement success rate (97.5%) at L5, with pedicle width >10.21 mm being a key predictor.
• Biomechanical analysis showed OLIF with ALTTS + BALS offered comparable stability to BPSF and superior stability to ASF, especially under normal bone density.
• Clinical evaluation revealed significant improvements in VAS and ODI scores postoperatively, with CT scans confirming intervertebral fusion at 3 months.

Conclusions:

• The ALTTS technique is predominantly suitable for the lower lumbar spine, particularly L5, offering high safety and success rates.
• OLIF combined with ALTTS + BALS provides superior biomechanical performance compared to OLIF with ASF.
• Preliminary clinical data suggest the ALTTS technique is a safe, feasible, and effective option for lumbar interbody fusion with positive short-term outcomes.