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Therefore, this study compared fully cortical-threaded MCBT screws with clinically used dual-threaded screws through an integrated experimental and finite element (FE) framework, spanning in vitro ovine vertebral biomechanical test and specimen-specific L4 vertebra and L1\u2013S1 fusion models. At the screw level, compared with the control group, fully cortical-threaded MCBT screws increased maximum pull-out strength by 111.2% and multidirectional stiffness by 75%\u201389% in L4 vertebral FE analysis, with biomechanical testing showing corresponding increases of 39.1% in insertion torque and 41.9% in maximum pull-out strength. At the fusion-construct level, fully cortical-threaded MCBT fixation limited fused-segment motion and decreased stress across the cage, instrumentation, and vertebral bone, indicating a more coordinated load-transfer pattern rather than a simple increase in interface-level strength. These effects were consistent across fusion strategies, but procedure-specific mechanics remained evident, with PLIF producing more symmetric load sharing and TLIF retaining intrinsic asymmetry owing to unilateral facet joint resection. Overall, the fully cortical-threaded screw design for MCBT promoted continuous and stable bone\u2013screw load transfer, translating interface-level gains into coordinated load distribution, greater fusion-construct stability, and lower deformation-driven stress concentration. These findings indicate that aligning screw architecture with the cortical-dominant load path is a mechanically rational design strategy within MCBT fixation, particularly in biomechanically demanding settings.<\/jats:p>","DOI":"10.1177\/09544119261461660","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T13:03:18Z","timestamp":1782651798000},"page":"663-675","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Biomechanical evaluation of a fully cortical-threaded screw for modified cortical bone trajectory fixation: Combined experimental and finite element study"],"prefix":"10.1177","volume":"240","author":[{"given":"Yixi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Minimally Invasive Spine and Precision Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Jingzhou First People\u2019s Hospital, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive Spine and Precision Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive Spine and Precision Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qihao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive Spine and Precision Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-0179","authenticated-orcid":false,"given":"Paerhati","family":"Rexiti","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive Spine and Precision Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000005265"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.22603\/ssrr.2021-0059"},{"key":"e_1_3_3_4_2","first-page":"6850","article-title":"Anatomical research on strength of screw track fixation in novel cortical bone trajectory for osteoporosis lumbar spine","volume":"11","author":"Rexiti P","year":"2019","unstructured":"Rexiti P, Aierken G, Wang S, et al. 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