{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:15:30Z","timestamp":1781525730334,"version":"3.54.1"},"reference-count":44,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Ulm, the department of Neurosurgery of the University of Ulm, and the department of Neurosurgery, Schulthess Clinic, Zurich"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>(1) Cage subsidence in spine surgery is a frequent clinical challenge. This study aimed to assess a novel screw augmentation technique for Transforaminal Lumbar Interbody Fusion in cadavers of reduced bone mineral density (BMD). (2) Forty human lumbar vertebrae (BMD 84.2 \u00b1 24.4 mgHA\/cm3, range 51\u2013119 mgHA\/cm3) were assigned to two groups: augmenting screw group and control group. The augmentation technique comprised placement of two additional subcortical screws. Ten constructs per group were loaded with a quasi-static load-to-failure protocol and other ten were cyclically loaded. Failure modes were documented. (3) During the quasi-static load-to-failure testing, the augmenting screw technique showed a significantly higher failure load (1426.0 \u00b1 863.6 N) versus the conventional technique in the control group (682.2 \u00b1 174.5 N, p = 0.032). Cyclic loading revealed higher number of cycles and corresponding load until reaching 5 mm subsidence and significantly higher number of cycles and corresponding load until reaching 10 mm subsidence for the augmenting screw technique (9645 \u00b1 3050; 1164.5 \u00b1 305.0 N) versus the conventional technique in the control group (5395 \u00b1 2340; 739.5 \u00b1 234.0 N, p &lt; 0.05). Failure modes were different and showed bending of the augmenting screws, followed by cut-out. (4) The investigated augmenting screw technique demonstrated higher failure loads and cycles to failure against cage subsidence compared to conventional cage placement. Failure modes were different between the two techniques and may lead to a different kind of complications.<\/jats:p>","DOI":"10.3390\/bioengineering12040337","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T07:46:50Z","timestamp":1742802410000},"page":"337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Augmenting Screw Technique to Prevent TLIF Cage Subsidence: A Biomechanical In Vitro Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7241-741X","authenticated-orcid":false,"given":"Alina","family":"Jacob","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, 89081 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4055-1906","authenticated-orcid":false,"given":"Alicia","family":"Feist","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0484-887X","authenticated-orcid":false,"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Caspar","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8358-1813","authenticated-orcid":false,"given":"Christian R.","family":"Wirtz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ulm, 89081 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-2480","authenticated-orcid":false,"given":"Geoff","family":"Richards","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-0476","authenticated-orcid":false,"given":"Markus","family":"Loibl","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Schulthess Clinic, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0437-8521","authenticated-orcid":false,"given":"Daniel","family":"Haschtmann","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Schulthess Clinic, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5231-5600","authenticated-orcid":false,"given":"Tamas F.","family":"Fekete","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Schulthess Clinic, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"752","DOI":"10.21037\/jss-20-492","article-title":"Trends in lumbar spinal fusion-a literature review","volume":"6","author":"Reisener","year":"2020","journal-title":"J. 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