scholarly journals Surgical Outcomes of Long Fusion Using Dual Iliac Screws Bilaterally for Adult Spinal Deformities: The Effect on the Loosening Rate and Sacroiliac Joint Correction

2019 ◽  
Vol 3 (3) ◽  
pp. 236-243
Author(s):  
Shigeto Ebata ◽  
Hiroki Oba ◽  
Tetsuro Ohba ◽  
Jun Takahashi ◽  
Shota Ikegami ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Sacroiliac Joint ◽  
Spinal Deformities ◽  
Iliac Screws ◽  
Loosening Rate

P82. Stability of Sacroiliac Joint after Long Fusion with and without Iliac Screws

2009 ◽  
Vol 9 (10) ◽  
pp. 157S
Author(s):  
Chunhui Wu ◽  
Honglin Teng ◽  
Xiujun Zheng ◽  
Rahul Chaudhari ◽  
Amir Mehbod ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Iliac Screws

Sacropelvic Fixation With S2 Alar Iliac Screws May Prevent Sacroiliac Joint Pain After Multisegment Spinal Fusion

Spine ◽  
2019 ◽  
Vol 44 (17) ◽  
pp. E1024-E1030 ◽  
Author(s):  
Eiki Unoki ◽  
Naohisa Miyakoshi ◽  
Eiji Abe ◽  
Takashi Kobayashi ◽  
Toshiki Abe ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Sacroiliac Joint Pain ◽  
Sacropelvic Fixation ◽  
Iliac Screws

scholarly journals Spine deformities in patients with cerebral palsy; the role of the pelvis

2020 ◽  
Vol 14 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Carol Hasler ◽  
Reinald Brunner ◽  
Alon Grundshtein ◽  
Dror Ovadia
Keyword(s):  
Cerebral Palsy ◽  
Sagittal Plane ◽  
Pelvic Obliquity ◽  
Sagittal Profile ◽  
Spinal Deformities ◽  
Pelvic Fixation ◽  
Equilibrium Control ◽  
Increased Risk ◽  
Iliac Screws ◽  
Spine Deformities

Introduction Progressive neuromuscular spinal deformities with pelvic obliquity and loss of sitting balance are typical features of severely affected patients with cerebral palsy. The pelvis represents the key bone between the spine and the lower extremity when it comes to deciding whether and when to operate and if spine or hip surgery first is beneficial. The pelvis can be looked at as the lowest vertebra and as the rooftop of the lower extremities. Biomechanical considerations To allow for a normal spinal shape, the pelvis needs to be horizontal in the frontal plane and mildly anterior tilted in the sagittal plane, less for sitting and more for standing. Any abnormal pelvic position requires spinal compensation and challenges the equilibrium control of the individual. Both anatomical neighbourhoods – the spine and the hip joints — have to be considered when spinal deformities, hip instability and contractures evolve, in conservative therapy (bracing, physiotherapy, seating in the wheelchair) and when surgical interventions are weighed out against each other. Surgical considerations Multiple anatomical factors such as sagittal profile and pelvic orientiation, pelvic transverse plane asymmetries and lumbosacral malformations have to be considered in case the pelvis is instrumented with sacral and iliac screws. Rotational deformities and asymmetries of the pelvic bones make the safe insertion of long screws challenging. Advantages of primary pelvic fixation include correction of pelvic obliquity, especially considering the lever arm of the whole spinal construct. The risk of revision surgery due to progression of distal curves is also reduced. Disadvantages of pelvic fixation include the complexity of the additional intervention, which may result in longer operating times, increased risk of blood loss, infection and hardware malpositioning.

scholarly journals Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

2020 ◽  
Author(s):  
Sandro M. Krieg ◽  
Nico Sollmann ◽  
Sebastian Ille ◽  
Lucia Albers ◽  
Bernhard Meyer
Keyword(s):  
Sacroiliac Joint ◽  
Comparison Study ◽  
Screw Loosening ◽  
Mineral Density ◽  
Biomechanical Force ◽  
Iliac Screws ◽  
The Mean ◽  
Caudal Level ◽  
Sacral Bone

Abstract Lumbosacral instrumentation continues to be challenging due to complex biomechanical force distributions and poor sacral bone quality. Various techniques have therefore been established. The aim of this study was to investigate the outcome of patients treated with S2-alar-iliac (S2AI), S2-alar (S2A), and iliac (I) instrumentation as the most caudal level. Sixty patients underwent one of the 3 techniques between January 2012 and June 2017 (S2AI 18 patients, S2A 20 patients, I 22 patients). Mean age was 70.4 ± 8.5 years. Screw loosening (SL) and sacroiliac joint (SIJ) pain were evaluated during the course at 3-month and maximum follow-up (FU). All patients completed 3-month FU, the mean FU period was 2.5 ± 1.5 years (p = 0.38), and a median of 5 segments was operated on (p = 0.26), respectively. Bone mineral density (BMD), derived opportunistically from computed tomography (CT), did not significantly differ between the groups (p = 0.66), but cages were more frequently implanted in patients of the S2A group (p = 0.04). SL of sacral or iliac screws was more common in patients of the S2A and I groups compared with the S2AI group (S2AI 16.7%, S2A 55.0%, I 27.3% of patients; p = 0.03). SIJ pain was more often improved in the S2AI group not only after 3 months but also at maximum FU (S2AI 61.1%, S2A 25.0%, I 22.7% of patients showing improvement; p = 0.02). Even in shorter or mid-length lumbar or thoracolumbar constructs, S2AI might be considered superior to S2A and I instrumentation due to showing lower incidences of caudal SL and SIJ pain.

Stereotactic navigation with the O-arm for placement of S-2 alar iliac screws in pelvic lumbar fixation

2013 ◽  
Vol 18 (5) ◽  
pp. 490-495 ◽  
Author(s):  
Wilson Z. Ray ◽  
Vijay M. Ravindra ◽  
Meic H. Schmidt ◽  
Andrew T. Dailey
Keyword(s):  
Sacroiliac Joint ◽  
Vascular Complications ◽  
Screw Placement ◽  
Computer Assisted ◽  
Long Term Outcome ◽  
Pelvic Fixation ◽  
Screw Length ◽  
Iliac Screws ◽  
Stereotactic Navigation ◽  
Iliac Fixation

Object Pelvic fixation is a crucial adjunct to many lumbar fusions to avoid L5–S1 pseudarthrosis. It is useful for treatment of kyphoscoliosis, high-grade spondylolisthesis, L5–S1 pseudarthrosis, sacral tumors, lumbosacral dislocations, and osteomyelitis. The most popular method, iliac fixation, has drawbacks including hardware prominence, extensive muscle dissection, and the need for connection devices. S-2 alar iliac fixation provides a useful primary or salvage alternative. The authors describe their techniques for using stereotactic navigation for screw placement. Methods The O-arm Surgical Imaging System allowed for CT-quality multiplanar reconstructions of the pelvis, and registration to a StealthStation Treon provided intraoperative guidance. The authors describe their technique for performing computer-assisted S-2 alar iliac fixation for various indications in 18 patients during an 18-month period. Results All patients underwent successful bilateral placement of screws 80–100 mm in length. All placements were confirmed with a second multiplanar reconstruction. One screw was moved because of apparent anterior breach of the ilium. There were no immediate neurological or vascular complications due to screw placement. The screw length required additional instruments including a longer pedicle finder and tap. Conclusions Stereotactic guidance to navigate the placement of distal pelvic fixation with bilateral S-2 alar iliac fixation can be safely performed in patients with a variety of pathological conditions. Crossing the sacroiliac joint, choosing trajectory, and ensuring adequate screw length can all be enhanced with 3D image guidance. Long-term outcome studies are underway, specifically evaluating the sacroiliac joint.

scholarly journals Reconstruction of Shattered Lumbo-Sacral Junction/Pelvis Utilizing Bilateral L4-Sacrum Fibula Strut Allograft And Double Iliac Screws Plus Routine Lumbar Pedicle Screw Fixation

2020 ◽  
Vol 11 ◽  
pp. 335
Author(s):  
Marc Agulnick ◽  
Benjamin R. Cohen ◽  
Nancy E. Epstein
Keyword(s):  
Pedicle Screw ◽  
Sacroiliac Joint ◽  
Pedicle Screws ◽  
Sacral Fracture ◽  
Reconstruction Technique ◽  
Pelvic Reconstruction ◽  
Fusion Construct ◽  
Joint Dislocation ◽  
Iliac Screws ◽  
Fibula Strut

Background: A traumatically shattered lumbosacral junction/pelvis may be difficult to repair. Here the authors offer a pelvic fixation technique utilizing routine pedicle screws, interbody lumbar fusions, bilateral iliac screws/ rods/crosslinks, and bilateral fibular strut allografts from the lumbar spine to the sacrum. Methods: A middle aged male sustained a multiple storey fall resulting in a left sacral fracture, and right sacroiliac joint (SI) dislocation. The patient had previously undergone attempted decompressions with routine pedicle screw L4-S1 fusions at outside institutions; these failed twice. When the patient was finally seen, he exhibited, on CT reconstructed images, MR, and X-rays, a left sacral fracture nonunion, and a right sacroiliac joint dislocation. Results: The patient underwent a bilateral pelvic reconstruction utilizing right L4, L5, S1 and left L4, L5 pedicle screws plus interbody fusions (L4-L5, and L5, S1), performed from the left. Unique to this fusion construct was the placement of bilateral double iliac screws plus the application of bilateral fibula allografts from L4-sacrum filled with bone morphogenetic protein (BMP). After rod/screw/connectors were applied, bone graft was placed over the fusion construct, including the decorticated edges of the left sacral fractures, and right SI joint dislocation. We additionally reviewed other pelvic fusion reconstruction methods. Conclusions: Here, we utilized a unique pelvic reconstruction technique utilizing pedicle screws/rods, double iliac screws/rods, and bilateral fibula strut grafts extending from the L4-sacrum filled with BMP.

A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model

2019 ◽  
Vol 30 (3) ◽  
pp. 367-375 ◽  
Author(s):  
Bryan W. Cunningham ◽  
Paul D. Sponseller ◽  
Ashley A. Murgatroyd ◽  
Jun Kikkawa ◽  
P. Justin Tortolani
Keyword(s):  
Sacroiliac Joint ◽  
Fatigue Loading ◽  
Axial Rotation ◽  
Biomechanical Analysis ◽  
Segmental Motion ◽  
Destructive Testing ◽  
Flexion Extension ◽  
Iliac Screws ◽  
Iliac Fixation

OBJECTIVEThe objective of the current study was to quantify and compare the multidirectional flexibility properties of sacral alar iliac fixation with conventional methods of sacral and sacroiliac fixation by using nondestructive and destructive investigative methods.METHODSTwenty-one cadaveric lumbopelvic spines were randomized into 3 groups based on reconstruction conditions: 1) S1–2 sacral screws; 2) sacral alar iliac screws; and 3) S1–iliac screws tested under unilateral and bilateral fixation. Nondestructive multidirectional flexibility testing was performed using a 6-degree-of-freedom spine simulator with moments of ± 12.5 Nm. Flexion-extension fatigue loading was then performed for 10,000 cycles, and the multidirectional flexibility analysis was repeated. Final destructive testing included an anterior flexural load to construct failure. Quantification of the lumbosacral and sacroiliac joint range of motion was normalized to the intact spine (100%), and flexural failure loads were reported in Newton-meters.RESULTSNormalized value comparisons between the intact spine and the 3 reconstruction groups demonstrated significant reductions in segmental flexion-extension, lateral bending, and axial rotation motion at L4–5 and L5–S1 (p < 0.05). The S1–2 sacral reconstruction group demonstrated significantly greater flexion-extension motion at the sacroiliac junction than the intact and comparative reconstruction groups (p < 0.05), whereas the sacral alar iliac group demonstrated significantly less motion at the sacroiliac joint in axial rotation (p < 0.05). Absolute value comparisons demonstrated similar findings. Under destructive anterior flexural loading, the S1–2 sacral group failed at 105 ± 23 Nm, and the sacral alar iliac and S1–iliac groups failed at 119 ± 39 Nm and 120 ± 28 Nm, respectively (p > 0.05).CONCLUSIONSAlong with difficult anatomy and weak bone, the large lumbosacral loads with cantilever pullout forces in this region are primary reasons for construct failure. All reconstructions significantly reduced flexibility at the L5–S1 junctions, as expected. Conventional S1–2 sacral fixation significantly increased sacroiliac motion under all loading modalities and demonstrated significantly higher flexion-extension motion than all other groups, and sacral alar iliac fixation reduced motion in axial rotation at the sacroiliac joint. Based on comprehensive multidirectional flexibility testing, the sacral alar iliac fixation technique reduced segmental motion under some loading modalities compared to S1–iliac screws and offers potential advantages of lower instrumentation profile and ease of assembly compared to conventional sacroiliac instrumentation techniques.

Different distal fixation anchors in lumbosacral spinal deformities associated with sacral agenesis: which one is better?

2021 ◽  
pp. 1-6
Author(s):  
Tianyuan Zhang ◽  
Hongda Bao ◽  
Shibin Shu ◽  
Zhen Liu ◽  
Xu Sun ◽  
...  
Keyword(s):  
Pelvic Obliquity ◽  
Spinal Deformities ◽  
Coronal Balance ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Group 3 ◽  
Group 2 ◽  
Distal Fixation ◽  
Group 1

OBJECTIVE Sacral agenesis (SA) is a rare congenital malformation of the spine. There has been a paucity of clinical research to investigate the surgical outcome of spinopelvic fixation in these patients. In this study, the authors aimed to evaluate the outcome of different distal fixation anchors in lumbosacral spinal deformities associated with SA and to determine the optimal distal fixation anchor. METHODS Patients with diagnoses of SA and lumbosacral scoliosis undergoing spinopelvic fixation with S1 screws, iliac screws, or S2-alar-iliac (S2AI) screws were analyzed. The main curve, coronal balance distance, and pelvic obliquity were compared at baseline, postoperatively, and during follow-up in three groups. The complications were also recorded. RESULTS A total of 24 patients were included: 8 patients were stratified into group 1 (S1 screws), 9 into group 2 (iliac screws), and 7 into group 3 (S2AI screws). The main curves were well corrected postoperatively (p < 0.05) in all groups. Coronal balance showed a tendency of deterioration during follow-up in patients with S1 screws (from 18.8 mm to 27.0 mm). Regarding pelvic obliquity, patients with both iliac and S2AI screws showed significant correction (from 3.7° to 2.3° and from 3.3° to 1.6°). Implant-related complications were rod breakage in 3 patients and infection in 1 patient in group 2, and no implant-related complications were observed in group 3. There were 3 cases of unilateral S1 pedicle screw misplacement in group 1. CONCLUSIONS Spinopelvic fixation is a safe and effective procedure that can achieve coronal correction in lumbosacral scoliosis associated with SA. Compared with S1 and iliac screws, S2AI screws as distal fixation anchors can achieve a more satisfactory correction with fewer implant-related complications.

scholarly journals A novel technique for stabilising sacroiliac joint dislocation using spinal instrumentation: technical notes and clinical outcomes

2022 ◽  
Author(s):  
Takahito Miyake ◽  
Kentaro Futamura ◽  
Tomonori Baba ◽  
Masayuki Hasegawa ◽  
Kanako Tsuihiji ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Sacroiliac Joint ◽  
Spinal Instrumentation ◽  
Fixation Method ◽  
Iliosacral Screw ◽  
Ilioinguinal Approach ◽  
Joint Dislocations ◽  
Iliac Screws ◽  
Fracture Dislocations

Abstract Purpose Currently, sacroiliac joint dislocations, including crescent fracture–dislocations, are treated using several techniques that have certain issues. We present the technical details and clinical outcomes of a new technique, anterior sacroiliac stabilisation (ASIS), performed using spinal instrumentation. Methods ASIS is performed with the patient in a supine position via the ilioinguinal approach. The displacements are reduced and fixed by inserting cancellous screws from the sacral ala and iliac brim; the screw heads are bridged using a rod and locked. We performed a retrospective review of patients with iliosacral disruption who underwent ASIS between May 2012 and December 2020 at two medical facilities. The patients were assessed for age, sex, injury type, associated injuries, complications, functional outcome by evaluating the Majeed pelvic score after excluding the sexual intercourse score and fracture union. Results We enrolled 11 patients (median age: 63 years). The median operative time was 195 min, median blood loss was 570 g, and eight patients (72.3%) required blood transfusion. The sacral and iliac screws had a diameter of 6.0–8.0 mm and 6.2–8.0 mm, and a length of 50–70 mm and 40–80 mm, respectively. Bone union was achieved with no marked loss of reduction in the median follow-up period of 12 months in all cases. The median Majeed score at the final follow-up was 85/96. Conclusion ASIS is a rigid internal fixation method that provides angular stability. Despite invasiveness issues compared to iliosacral screw fixation, this method is easy to confirm and achieves precise reduction.

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