We sincerely appreciate the authors’ thoughtful and constructive commentary on our article, “Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis.” [1] The points raised suggest important methodological considerations for improving the clinical relevance of finite element analyses.

We agree that pedicle screw loosening is a fatigue-driven process influenced by cyclic loading, micromotion, and interface degradation, and that static peak von Mises stress (PVMS) may not fully capture these complex mechanisms. However, the primary aim of our study was to comparatively evaluate the relative biomechanical effects of different cement augmentation strategies on screw stability, adjacent segment biomechanics, and implant-related failure risk under standardized conditions. Specifically, our findings may offer biomechanical insights that help inform surgical decision-making by delineating relative trends among different reinforcement configurations in terms of stability and adjacent segment biomechanics. Within this framework, PVMS was used as a relative comparative indicator, rather than an absolute predictor of clinical failure.

To simulate physiological loading, we applied a validated hybrid loading protocol (pure moment combined with follower load), which has been widely used to reproduce spinal motion and load transmission. We acknowledge that this approach differs from cyclic fatigue protocols and does not directly assess time-dependent loosening behavior. All bone-implant and cement-implant interfaces were defined as tied contact to ensure consistency across models and to represent an idealized initial fixation state.

Importantly, while the suggested methodological improvements—such as cyclic loading and frictional contact—would help refine future modeling, they do not alter the main comparative conclusions of our current study regarding the relative trends between different augmentation strategies. As noted in our limitations, our results should be interpreted as relative comparisons between models rather than direct representations of clinical loosening phenomena.

Incorporating the proposed metrics represents an important direction for future studies, and we will explore these considerations in our subsequent work. We thank the authors for their constructive suggestions, which have helped clarify the scope and implications of our study.

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