What does this research mean for the field?

In L4-L5 Posterior Lumbar Interbody Fusion (PLIF) surgery, no single screw construct or cage implantation angle is uniformly favorable across all biomechanical parameters, as cortical bone trajectory (CBT) screws achieve the highest range of motion at 45° but with elevated disc stress, while modified CBT screws show lower disc stress and moderate range of motion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the biomechanical effects of different pedicle screw constructs and interbody cage implantation angles on stability and stress in L4-L5 posterior lumbar interbody fusion (PLIF).

August 31, 2026BMC Musculoskeletal DisordersOpen Access

Biomechanical evaluation of various cage implantation angles and screw constructs in L4-5 PLIF surgery: a finite element study

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Authors

HHHali HabulihanXinjiang Medical University AMAoran Maheshati JYJitao YangXinjiang Medical University

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Implication

Finite element study evaluates spinal stability across screw constructs and cage angles in osteoporotic models, indicating varied biomechanical trade-offs.

Key Points

To evaluate the biomechanical effects of different pedicle screw constructs and interbody cage implantation angles on stability and stress in L4-L5 posterior lumbar interbody fusion (PLIF).
Constructed finite element models of the L1-S1 segment using three osteoporotic cadaveric specimens.
Simulated L4-L5 PLIF using three screw constructs (traditional trajectory [TT-TT], cortical bone trajectory [CBT-CBT], and modified CBT [MCBT-MCBT]) paired with cage insertion angles of 30°, 45°, 60°, and 90°.
Analyzed range of motion (ROM), disc stress, and hardware stress under physiological loading conditions using ANSYS Workbench 19.1.
A 45° cage angle generated the highest ROM across all screw constructs in most motion directions.
CBT screws produced greater intervertebral disc stress, particularly at 45° and 60°, alongside elevated rod stress at 60° and 90°.
MCBT screws showed lower disc stress and moderate ROM, but exhibited higher screw stress during lateral bending and higher rod stress during axial rotation.

Cite This Study

Habulihan et al. (2026) studied this question.

synapsesocial.com/papers/6a95427bf20e493292a74dc6 https://doi.org/10.1186/s12891-026-10428-5

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Implication

Finite element study evaluates spinal stability across screw constructs and cage angles in osteoporotic models, indicating varied biomechanical trade-offs.

Biomechanical evaluation of various cage implantation angles and screw constructs in L4-5 PLIF surgery: a finite element study

Discussion

Member takes

Implication

Key Points

Cite This Study

Biomechanical evaluation of various cage implantation angles and screw constructs in L4-5 PLIF surgery: a finite element study

Discussion

Member takes

Implication

Key Points

Cite This Study

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