scholarly journals S-1 and S-2-alar-iliac screw fixation via intraoperative navigation

2016 ◽  
Vol 41 (videosuppl1) ◽  
pp. 1
Author(s):  
Martin H. Pham ◽  
Andre M. Jakoi ◽  
Patrick C. Hsieh
Keyword(s):  
Spinal Deformity ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Intraoperative Navigation ◽  
Case Presentation ◽  
Adult Deformity ◽  
Sacropelvic Fixation ◽  
Fixation Techniques ◽  
Iliac Screw ◽  
Bicortical Screw

Adult deformity patients often require fixation to the sacrum and pelvis for construct stability and improved fusion rates. Although certain sacropelvic fixation techniques can be challenging, the availability of intraoperative navigation has made many of these techniques more feasible. In this video case presentation, the authors demonstrate the techniques of S-1 bicortical screw and S-2-alar-iliac screw fixation under intraoperative navigation in a 67-year-old female. This instrumentation placement was part of an overall T-10–pelvis construct for the correction of adult spinal deformity.The video can be found here: https://youtu.be/3HZo-80jQr8.

scholarly journals Association between bicortical screw fixation at upper instrumented vertebra and risk for upper instrumented vertebra fracture

2017 ◽  
Vol 26 (5) ◽  
pp. 638-644 ◽  
Author(s):  
Young-Seop Park ◽  
Seung-Jae Hyun ◽  
Ho Yong Choi ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng
Keyword(s):  
Spinal Deformity ◽  
Pelvic Incidence ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
The Mean ◽  
Upper Instrumented Vertebra ◽  
Bicortical Screw

OBJECTIVEThe aim of this study was to investigate the risk of upper instrumented vertebra (UIV) fractures associated with UIV screw fixation (unicortical vs bicortical) and polymethylmethacrylate (PMMA) augmentation after adult spinal deformity surgery.METHODSA single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥ 4 levels (that is, the lower instrumented vertebra at the sacrum or pelvis and the UIV of the thoracolumbar spine [T9–L2]) were retrospectively reviewed. Age, sex, follow-up duration, sagittal UIV angle immediately postoperatively including several balance-related parameters (lumbar lordosis [LL], pelvic incidence, and sagittal vertical axis), bone mineral density, UIV screw fixation type, UIV PMMA augmentation, and UIV fracture were evaluated. Patients were divided into 3 groups: Group U, 15 patients with unicortical screw fixation at the UIV; Group P, 16 with bicortical screw fixation and PMMA augmentation at the UIV; and Group B, 21 with bicortical screw fixation without PMMA augmentation at the UIV.RESULTSThe mean number of levels fused was 6.5 ± 2.5, 7.5 ± 2.5, and 6.5 ± 2.5; the median age was 50 ± 29, 72 ± 6, and 59 ± 24 years; and the mean follow-up was 31.5 ± 23.5, 13 ± 6, and 24 ± 17.5 months in Groups U, P, and B, respectively (p > 0.05). There were no significant differences in balance-related parameters (LL, sagittal vertical axis, pelvic incidence–LL, and so on) among the groups. UIV fracture rates in Groups U (0%), P (31.3%), and B (42.9%) increased in sequence by group (p = 0.006). UIV bicortical screw fixation increased the risk for UIV fracture (OR 5.39; p = 0.02).CONCLUSIONSBicortical screw fixation at the UIV is a major risk factor for early UIV compression fracture, regardless of whether a thoracolumbosacral orthosis is used. To reduce the proximal junctional failure, unicortical screw fixation at the UIV is essential in adult spinal deformity correction surgery.

A Novel Junctional Tether Weave Technique for Adult Spinal Deformity: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E45-E46 ◽  
Author(s):  
Thomas J Buell ◽  
Jeffrey P Mullin ◽  
James H Nguyen ◽  
Davis G Taylor ◽  
Juanita Garces ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Pedicle Screws ◽  
Iliac Crest Bone Graft ◽  
Cobalt Chromium ◽  
Sagittal Vertical Axis ◽  
Medical Publication ◽  
Iliac Screw

Abstract Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation for adult spinal deformity. Various anti-PJK techniques such as junctional tethers for ligamentous augmentation have been proposed. We present an operative video demonstrating technical nuances of junctional tether “weave” application. A 70-yr-old male with prior L2-S1 instrumented fusion presented with worsening back pain and posture. Imaging demonstrated pathological loss of lumbar lordosis (flat back deformity), proximal junctional failure, and pseudarthrosis. The patient had severe global and segmental sagittal malalignment, with sagittal vertical axis (SVA, C7-plumbline) measuring 22.3 cm, pelvic incidence (PI) 55°, lumbar lordosis (LL) 8° in kyphosis, pelvic tilt (PT) 30°, and thoracic kyphosis (TK) 6°. The patient gave informed consent for surgery and use of imaging for medical publication. Briefly, surgery first involved re-instrumentation with bilateral pedicle screws from T10 to S1. After right-sided iliac screw fixation (left-sided iliac screw fixation was not performed due to extensive prior iliac crest bone graft harvesting), we then completed a L2-3 Smith–Petersen osteotomy, extended L4 pedicle subtraction osteotomy, and L3-4 interbody arthrodesis with a 12° lordotic cage (9 × 14 × 40 mm). Cobalt Chromium rods were placed spanning the instrumentation bilaterally, and accessory supplemental rods spanning the PSO were attached. An anti-PJK junctional tether “weave” was then implemented using 4.5 mm polyethylene tape (Mersilene tape [Ethicon, Somerville, New Jersey]). Postoperative imaging demonstrated improved alignment (SVA 2.8 cm, PI 55°, LL 53°, PT 25°, TK 45°) and no significant neurological complications occurred during convalescence or at 6 mo postop.

scholarly journals Comparison of Radiographic And Clinical Outcomes Observed After Adult Spinal Deformity Correction Using Iliac Screw Versus S2-Alar-Iliac Screw

2021 ◽  
Author(s):  
Qiang Luo ◽  
Yong-Chan Kim ◽  
Ki-Tack Kim ◽  
Kee-Yong Ha ◽  
Joonghyun Ahn ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Postoperative Change ◽  
Iliac Screw ◽  
Vas Scores ◽  
Correction Surgery

Abstract Background: To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.Methods: A retrospective review of consecutive patients underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change <5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.Results: A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26, 39.8 ± 13.8) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9, 30.3 ± 9.9) (p<0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p<0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p<0.05) and (16.1% vs 3.6%, p<0.05).Conclusions: IS fixation showed a greater change in LL and ULL than S2AI fixation in ASD surgery. PI may be changed under certain circumstances.

The Incidence of Iliac Screw-Related Complications After Long Fusion Surgery in Patients with Adult Spinal Deformity

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tomohiro Banno ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Hideyuki Arima ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Fusion Surgery ◽  
Iliac Screw

Long-Term Outcomes and Complications of Unilateral vs Bilateral Iliac Screw Fixation in Adult Deformity Surgery

2017 ◽  
Vol 17 (10) ◽  
pp. S169
Author(s):  
Michael S. Chang ◽  
Dennis G. Crandall ◽  
Jan Revella ◽  
Yu-Hui Chang
Keyword(s):  
Screw Fixation ◽  
Long Term Outcomes ◽  
Adult Deformity ◽  
Iliac Screw

scholarly journals Biomechanical Evaluation of Sagittal Split Ramus Osteotomy Fixation Techniques in Mandibular Setback

2020 ◽  
Vol 10 (9) ◽  
pp. 3031
Author(s):  
Michael Y. C. Chen ◽  
Yi-Fan Wu ◽  
Heng-Li Huang ◽  
Jui-Ting Hsu
Keyword(s):  
Screw Fixation ◽  
Resistance Force ◽  
Sagittal Split Ramus Osteotomy ◽  
Mandibular Setback ◽  
Significant Difference ◽  
Fixation Techniques ◽  
Group 3 ◽  
Group 2 ◽  
Bicortical Screw ◽  
Group 1

The objective of this study was to evaluate and compare the biomechanical behavior of internal fixation techniques in bilateral sagittal split ramus osteotomies (BSSROs) for mandibular setback. Artificial polyurethane mandibles were used in this study. The distal segment of the mandible was repositioned in an 8-mm setback position. All mandibles were divided into three groups: Group 1 had a straight plate with a four-hole monocortical fixation, Group 2 had a curved plate with a four-hole monocortical fixation, and Group 3 had a three–inverted L-type bicortical screw fixation. Vertical loads were applied on the incisal edge by a material testing system. The resistance force at 1, 3, 5, and 10 mm of displacement was analyzed. From the experimental results, Group 1 showed significantly lower results than Groups 2 and 3. No significant difference was observed between Groups 2 and 3 at 1, 3, and 5 mm of displacement. However, at 10 mm of displacement, the resistance force of Group 3 was greater than that of Group 2. For BSSROs, this study concluded that curved plate fixation exhibited the same rigidity as the inverted-L bicortical screw fixation did at ≤5 mm displacement.

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