Objective: Given the limitations of current oblique lateral lumbar interbody fusion (OLIF) with internal fixation—such as long operation time, high blood loss, and soft tissue injury—this study evaluates the feasibility, preliminary effectiveness, and biomechanical properties of a modified Anterolateral Transpedicular Transverse Process Screw (ALTTS) technique.
Methods: ALTTS screw placement success rate and key vertebral parameters were evaluated via CT-based simulation in 40 patients (L1–L5). A finite element model of L3-S1 was constructed to compare three OLIF constructs: ALTTS plus bilateral anterolateral screws (ALTTS + BALS), anterior supplemental fixation (ASF), and bilateral pedicle screw fixation (BPSF). Range of motion (ROM), fixation instrument stress, and cage stress were assessed under varying bone quality. Clinically, 12 patients undergoing OLIF with L5 ALTTS and L4 BALS fixation were evaluated using VAS, ODI, and imaging.
Results: Of 200 vertebral bodies, 81 (40.5%) were suitable for ALTTS. The success rate was 0% at L1–L2, 2.5% at L3 (due to vascular constraints), and 97.5% at L5, indicating ALTTS is primarily suitable for the lower lumbar spine, specifically L5. A pedicle width (PW) > 10.21 mm was a key predictor significantly increasing placement success. Biomechanically, under normal bone density, OLIF with ALTTS + BALS demonstrated comparable ROM and stress distribution to BPSF and outperformed ASF. Under osteoporotic conditions, its stability remained superior to ASF but inferior to BPSF. Clinically, the 12 patients showed significant postoperative improvement in VAS and ODI scores, with 3-month CT scans indicating intervertebral fusion, confirming preliminary safety and short-term efficacy.
Conclusions: ALTTS is a lower-lumbar-predominant technique, offering the highest safety and placement success rate at L5, particularly when PW > 10.21 mm. Biomechanically, OLIF with ALTTS + BALS significantly outperforms OLIF with ASF. Preliminary clinical results demonstrate the novel technique is safe, feasible, and effective over a six-month follow-up.
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