Background: The most common complication of oblique lumbar interbody fusion (OLIF) is cage subsidence. OLIF combined with internal fixation could help decrease the cage subsidence and increase the fusion rate. The aim of this study was to evaluate the biomechanical feasibility and safety in the patients undergoing OLIF surgery with anterolateral screw fixation (ASF). Methods: Based on our previous validated model , L4-L5 functional surgical models corresponding to the ASF and Bilateral pedicle screw fixation(BPSF) methods were created. A 500 N compression force was applied to the superior surface of the model to represent the upper body weight, and a 7.5 Nm moment was applied to simulate the six movement directions of the lumbar spinal model: flexion/extension, right/left lateral bending and right/left axial rotation. Finite element (FE) models were developed to compare the biomechanics of the ASF and BPSF groups. Results: Compared to the range of motion (ROM) of the intact lumbar model, that of the ASF model was decreased by 82.0% in flexion, 60.0% in extension, and the BPSF model was decreased by 86.7% in flexion, 77.3% in extension. Compared to the BPSF model, the maximum stresses of the L4 inferior endplate (IEP) and L5 superior endplate (SEP) were greatly increased in the ASF model; The contact surface between vertebrae and screw (CSVS) in the ASF model produced nearly100% more stresses than the BPSF model in all moment .Conclusions: OLIF surgery with ASF could not reduce the maximum stresses on the endplate and CSVS, which may be a potential risk factor for cage subsidence and screw loosening.
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