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Jiang J, Song C, Wang H, Qiu Y, Wang B, Zhu Z, Yu Y. The Influence of Radiographic Parameter on the S2 Alar-Iliac Screw Virtual Trajectory in Degenerative Lumbar Scoliosis Patients: A Computed Tomography Study. Orthop Surg 2024; 16:1356-1363. [PMID: 38664914 PMCID: PMC11144505 DOI: 10.1111/os.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE S2 alar-iliac (S2AI) screw had been widely used in the pelvic fusion for degenerative lumbar scoliosis (DLS) patients. However, whether S2AI screw trajectory was influenced by sagittal profile in DLS patients had not been comprehensively investigated. The objective of this study was to evaluate the associations between the optimal S2 alar-iliac (S2AI) screw trajectory and sagittal spinopelvic parameters in DLS patients. METHODS Computed tomography (CT) scans of pelvis were performed in 47 DLS patients for three-dimensional reconstruction of S2AI screw trajectory from September 2019 to November 2021. Five S2AI screw trajectory parameters were measured in CT reconstruction images, including: 1) angle in the transverse plane (Tsv angle); 2) angle in the sagittal plane (Sag angle); 3) maximal screw length; 4) screw width; and 5) skin distance. The lumbar Cobb angle, lumbar apical vertebral translation (AVT); global kyphosis (GK); thoracic kyphosis (TK); lumbar lordosis (LL); sagittal vertical axis (SVA); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI) were measured in standing X-ray films of the whole spine and pelvis. RESULTS Both Tsv angle and Sag angle had significant positive associations with SS (p < 0.05) but negative associations with both PT (p < 0.05) and LL (p < 0.05) in all cases. Patients with SS less than 15° had both smaller Tsv angle and Sag angle than those with SS equal to or more than 15° (p < 0.05). The decreased LL would lead to the backward rotation of the pelvis, resulting in a more cephalic and less divergent trajectory of S2AI screw in DLS patients. CONCLUSIONS For DLS patients with lumbar kyphosis, spine surgeons should avoid both excessive Tsv and Sag angles for S2AI screw insertion, especially when using free-hand technique.
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Affiliation(s)
- Jun Jiang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
| | - Chenyu Song
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
| | - Han Wang
- Department of Radiology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityJiangsuChina
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Kimura R, Kasukawa Y, Hongo M, Kudo D, Mita M, Nozaka K, Miyakoshi N. Skip Fusion With Sacral-Alar-Iliac Screw Fixation for Pelvic Ring and Lumbar Fractures: A Case Report. Cureus 2023; 15:e50022. [PMID: 38186526 PMCID: PMC10767426 DOI: 10.7759/cureus.50022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Pelvic ring fractures are associated with high-energy trauma and high mortality owing to critical blood loss and concomitant injuries. If there is a concurrent lumbar fracture, the postoperative range of motion will be limited owing to the increased fusion range. Here, we report a case in which skip fusion with sacral-alar-iliac screw fixation was effective as a minimally invasive procedure for treating pelvic ring and lumbar fractures.
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Affiliation(s)
- Ryota Kimura
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Yuji Kasukawa
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Michio Hongo
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Daisuke Kudo
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Motoki Mita
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Koji Nozaka
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Naohisa Miyakoshi
- Orthopaedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
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Kaul R, Goswami B, Kumar K, Jeyaraman M, Sangondimath G, Chhabra HS. A Computed Tomography-Based Assessment of the Anatomical Parameters Concerning S2-Alar Iliac Screw Insertion Using "Safe Trajectory Method" in Indian Population. Asian Spine J 2023; 17:130-137. [PMID: 35527531 PMCID: PMC9977994 DOI: 10.31616/asj.2022.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/20/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN A retrospective computed tomography (CT)-based radiological analysis. PURPOSE To obtain CT-based morphometric data for the S2 alar iliac (S2AI) screw in the Indian population presenting to School of Medical Sciences and Research, Greater Noida, we used the concept of "safe trajectory" by Pontes and his colleagues in a recent study. OVERVIEW OF LITERATURE Although previous CT-based morphometric studies on the S2AI screw have been published for a variety of ethnic groups, morphometric data specifically for the Indian population are scarce. METHODS We used the three-dimensional multiplanar reformatting software to conduct a retrospective CT analysis of 112 consecutive patients who met our exclusion criteria for various abdominal and pelvic pathologies. CT imaging planes were rotated between the S1 and S2 foramen until they matched the ideal S2AI screw trajectory, which was represented by the longest and widest iliac osseous channel observed in the axial CT section. Following the concept of a safe trajectory, S2AI screw morphometric parameters were measured on both sides of the pelvis using corresponding axial and sagittal CT images. RESULTS In the sagittal and transverse planes on both sides of the pelvis, females had significantly higher screw trajectory angulation than males (p<0.001). On both sides of the pelvis, males had significantly greater iliac width, maximum screw trajectory length, and intrascrotal length than females (p<0.001). On both sides of the pelvis, the S2AI screw entry point in females was significantly deeper than in males from the skin margin (p<0.001). CONCLUSIONS Based on our methodology, we discovered that the S2AI screw trajectory is significantly more caudal and lateral in females, the maximum screw length is sufficient for use in clinical practice regardless of gender, and that 8.5 mm or even larger screw diameters are feasible in the majority of the Indian population.
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Affiliation(s)
- Rahul Kaul
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida,
India
| | - Bharat Goswami
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida,
India
| | - Khemendra Kumar
- Department of Radio Diagnosis, School of Medical Sciences and Research, Sharda University, Greater Noida,
India
| | - Madhan Jeyaraman
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida,
India
| | | | - HS Chhabra
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi,
India
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Intraoperative imaging and navigated spinopelvic instrumentation: S2-alar-iliac screws combined with tricortical S1 pedicle screw fixation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2587-2596. [PMID: 35771266 DOI: 10.1007/s00586-022-07268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/02/2022] [Accepted: 05/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The present study aimed to assess the feasibility, safety and accuracy of navigated spinopelvic fixation with focus on S2-alar-iliac screws (S2AIS) and tricortical S1 pedicle screw implantation with the use of high-resolution three-dimensional intraoperative imaging and real-time spinal navigation. METHODS Patients undergoing navigated intraoperative CT-based spinopelvic stabilization between January 2016 and September 2019 were included. Pelvic fixation was achieved by implantation of S2AIS or iliac screws (IS). S1 screws were implanted with the goal of achieving tricortical purchase. In all cases, instrumentation was performed with real-time spinal navigation and intraoperative screw positioning was assessed using intraoperative computed tomography (iCT), cone-beam CT (CBCT) and robotic cone-beam CT (rCBCT). Screw accuracy was evaluated based on radiographic criteria. To identify predictors of complications, univariate analysis was performed. RESULTS Overall, 52 patients (85%) received S2AIS and nine patients (15%) received IS instrumentation. Intraoperative imaging and spinal navigation were performed with iCT in 34 patients, CBCT in 21 patients and rCBCT in six patients. A total number of 10/128 (7.8%) iliac screws underwent successful intraoperative correction due to misalignment. Tricortical purchase was successfully accomplished in 58/110 (53%) of the S1 screws with a clear learning curve in the course of time. S2AIS implantation was associated with significantly fewer surgical side infection-associated surgeries. CONCLUSIONS Real-time navigation facilitated spinopelvic instrumentation with increasing accuracy of S2AIS and tricortical S1 screws. Intraoperative imaging by iCT, CBCT or rCBCT permitted screw assessment with the chance of direct navigated revision of misplaced iliac screws to avoid secondary screw revision surgery.
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Radio-anatomical study of anterior-posterior placement sacroiliac screw channel. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2572-2578. [PMID: 35687271 DOI: 10.1007/s00586-022-07257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/19/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The outlet of the classic sacroiliac screw (SIS) cannot be precisely controlled by aiming devices, which may lead to malpositioned implants and neurovascular and visceral injury. This study aimed to radio-anatomically measure the parameters of the channel for anterior-posterior placement SIS (AP-SIS), which can be placed percutaneously with an aiming device. METHODS Pelvic CT scan data of 80 healthy adults (40 males and 40 females) with an average age of 45 years (range 20-70 years) were collected. The length (L), width (W), height (H), cortical bone spacing (M), camber angle (E), anteversion angle (F), cross-sectional safety angle (P) and sagittal safety angle (Q) of the channel were measured by CT or Mimics software. RESULTS The L, W, H, M, E, F, P and Q measures of S1 were 109.2 ± 8.0 mm, 18.5 ± 1.9 mm, 21.7 ± 1.7 mm, 8.1 ± 0.4 mm, 44.2 ± 3.2°, 42.4 ± 3.6°, 16.8 ± 1.1°, and 19.4 ± 2.0°, respectively, for S1, and 113.5 ± 9.4 mm, 18.2 ± 1.5 mm, 21.7 ± 1.7 mm, 7.7 ± 0.4 mm, 44.7 ± 3.2°, 31.2 ± 2.7°, 13.8 ± 1.0° and 15.4 ± 1.4°, respectively, for S2. Of the L measures, the intra-iliac segment was slightly longer than the intra-sacral segment. All parameters showed significant sex-related differences (p < 0.05). CONCLUSION The AP-SIS channels of S1-2 have sufficient width and length to accommodate a cancellous screw with a Φ 7.0-8.0 mm and a length 90-130 mm. The intra-iliac segment is a long channel screw with better mechanical properties over classic SIS.
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The lateral entry point S2 alar-iliac (L-S2AI) screw: a preoperative computed tomography analysis of adult spinal deformity patients. Spine Deform 2022; 10:669-678. [PMID: 35088384 DOI: 10.1007/s43390-021-00462-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To radiographically compare lateral entry point S2-alar-iliac (L-S2AI) screw with conventional S2AI (C-S2AI) and conventional iliac screw (CIS) lengths and trajectories. METHODS Twenty-five preoperative CT scans of consecutive patients undergoing adult spinal deformity realignment surgery over a random 2-year period were analysed. Maximum in-bone length, caudal and lateral trajectories of CIS, C-S2AI, and L-S2AI screws were measured and compared using One-way ANOVA with Tukey's post hoc tests. Multivariate logistic regression was performed to identify predictors of high screw length discrepancy between C-S2AI and L-S2AI. RESULTS Potential screw length was longest for CIS, followed by L-S2AI, then C-S2AI (114.5 ± 8.3 mm vs 101.4 ± 9.6 mm vs 80.6 ± 5.9 mm, respectively) in all patients (p < 0.001). Actual screw lengths found both CIS and L-S2AI to be longer than C-S2AI (95.3 ± 8.5 mm and 93.4 ± 7.5 mm vs 82.1 ± 7.3 mm; p = 0.008 and 0.003). Potential lateral angulation was smallest for CIS, followed by L-S2AI, then C-S2AI (21.9 ± 7.0° vs 31.9 ± 7.1° vs 40.9 ± 6.7°, respectively) in all patients (p < 0.001). L-S2AI and C-S2AI had the same caudal angulation (24.9 ± 6.8°), which was smaller than CIS (30.8 ± 5.8°) in all patients (p < 0.001). Univariate, but not multivariate analysis, revealed that lumbar lordosis > 40° (OR 7.2, p = 0.041), diagnosis of degenerative spondylolisthesis (OR 10.5, p = 0.017), and > 7 instrumented levels (OR 2.6, p = 0.049) were significantly associated with high screw discrepancies. CONCLUSION The L-S2AI screw combines advantages of CIS and C-S2AI screws, which includes increased screw length, reduced lateral angulation, a low-profile screw head, ease of connection to proximal hardware, and the biomechanical advantage of a quadcortical purchase.
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Luo Y, Li Y, He L, Yin E, Gu M, Xu Z, Chen H, Hou Z, Yi C. Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures. Injury 2022; 54 Suppl 2:S8-S14. [PMID: 35180997 DOI: 10.1016/j.injury.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the surgical methods and clinical effects of lumbopelvic fixation (LPF) with S2 alar-iliac (S2AI) screws for U-shaped sacral fractures. METHODS From December 2019 to August 2020, 14 patients with U-shaped sacral fractures were treated with LPF using S2AI screws. Demographics, fracture classification, mechanism of injury, surgical treatment, complications and clinical results were assessed. All patients had a LPF with or without nerve decompression. The reduction quality was evaluated according to the Matta criteria. Neurological function was evaluated according to the Gibbons grading. The activities of daily life were evaluated according to the Majeed scoring system at the last follow-up. RESULTS Among 14 consecutive patients with U-shaped sacral fractures, the age at injury ranged from 13 to 72 years (average 30.3 ± 17.5 years). There were 4 males and 10 females. All patients were followed up for 6-15 months (average 7.8 ± 2.7 months). Thirteen patients were fixed with bilateral S2AI screws, and one patient was fixed only unilaterally due to unilateral spinopelvic dissociation. The excellent and good rate of postoperative pelvic reduction quality was 92% (excellent 10, good 3, fair 1). At the latest follow-up, the excellent and good rate of pelvic function was 100% (excellent 9, good 5) and all patients achieved different extents of neurological recovery. One patient had a postoperative superficial surgical site infection, which healed after debridement. Radiological examination at 3-6 months after operation showed that all fractures had healed. No complications were found in any patients during follow-up, such as implant fracture, loss of reduction, deep wound infection, wound dehiscence and screw protrusion discomfort. CONCLUSION LPF with S2AI screws for the treatment of U-shaped sacral fractures has exhibited distinct advantages, including firm fixation, a low rate of surgical site complications and satisfactory clinical efficacy. This approach provides sufficient stability to accelerate the commencement of postoperative rehabilitation.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Enzhi Yin
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhe Xu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Chen
- Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Luo Y, Li Y, He L, Yi C. S2-Alar-Iliac Screw Fixation versus Iliac Screw Fixation in the Treatment of Sacral Fractures. J INVEST SURG 2022; 35:1224-1230. [PMID: 34974780 DOI: 10.1080/08941939.2021.2022253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the short-term therapeutic effects of S2-alar-iliac (S2AI) screw fixation and iliac screw fixation techniques in managing sacral fractures. METHODS From September 2015 to May 2020, 42 patients with sacral fractures who underwent lumbopelvic fixation by a single surgeon were analyzed. The patients were divided into the S2AI screw group (19 patients) and the iliac screw group (23 patients). Operative data, reduction quality, postoperative complications, and functional outcomes were evaluated. RESULTS The incidence of unplanned reoperation was significantly different between patients treated with S2AI screws than in those treated with iliac screws (0 versus 6, p = 0.02). The mean intraoperative estimated blood loss was 405.26 ± 229.67 mL in the S2AI screw group and 539.13 ± 246.32 mL in the iliac screw group (P = 0.08). No significant difference was observed in either group regarding the quality of reduction, functional outcome, or low back pain. The reduction quality based on the Matta criteria and excellent/good outcomes were 21/2 in the iliac screw group and 17/2 in the S2AI screw group. The functional outcomes based on the Majeed score and excellent/good/fair outcomes were 17/3/3 in the iliac screw group and 17/1/1 in the S2AI screw group. No complications, including implant breakage, loosening of the implant, or loss of reduction were found in either group during follow-up. CONCLUSION Both S2AI screws and iliac screws were effective in the treatment of sacral fractures. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for surgical site infection, wound dehiscence, and symptoms of screw protrusion than the use of iliac screws.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Matsukawa K, Abe Y, Mobbs RJ. Novel Technique for Sacral-Alar-Iliac Screw Placement Using Three-Dimensional Patient-Specific Template Guide. Spine Surg Relat Res 2021; 5:418-424. [PMID: 34966869 PMCID: PMC8668215 DOI: 10.22603/ssrr.2020-0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The sacral-alar-iliac (SAI) screw technique is becoming popular for sacropelvic fixation. However, appropriately placing SAI screws is technically demanding because of a narrow safe corridor and the risk of neurovascular/visceral injuries. Recently, a three-dimensional patient-specific template guiding technique for pedicle screw placement has been considered a promising method to improve accuracy and safety. The objective of the present study was to investigate the accuracy of SAI screw placement with a patient-specific template guide using cadaveric and prospective clinical pilot studies. Methods Three-dimensional planning of SAI screw placement, including entry point, screw trajectory, length, and diameter, was performed using a computer simulation software. Then, three-dimensional printed patient-specific template guides were created based on the plan. Firstly, a total of 12 SAI screws were placed for 6 cadaveric specimens using the guides. Next, in a prospective clinical trial, a total of 20 SAI screws were placed for 10 consecutively enrolled patients. The safety and accuracy of screw placement were analyzed using postoperative computed tomography by the evaluation of any cortical breach and measurement of screw deviations between the planned and actual screw positions. Results All the screws showed no perforation. In the cadaveric study, the mean horizontal and vertical deviations from the planned screw position at the entry point were 1.40±1.21 mm and 1.34±1.09 mm, respectively. The mean angular deviations in the sagittal and transverse planes were 1.68°±1.24° and 1.53°±1.06°, respectively. The results of the clinical study showed comparable accuracy with those of the cadaveric study, except for the vertical deviation at the entry point (p=0.048). Conclusions This is the first study to evaluate the feasibility and accuracy of using a patient-specific template guide for SAI screw placement. This technique could become an effective solution to achieve accurate screw placement.
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Affiliation(s)
- Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Japan
| | - Ralph Jasper Mobbs
- Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Level 7, Prince of Wales Private Hospital, Sydney, Australia
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Matsukawa K, Kato T, Mobbs R, Yato Y, Asazuma T. Combination of sacral-alar-iliac screw and cortical bone trajectory screw techniques for lumbosacral fixation: technical note. J Neurosurg Spine 2020; 33:186-191. [PMID: 32197252 DOI: 10.3171/2020.1.spine191420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbosacral fixation plays an important role in the management of devastating spinal pathologies, including osteoporosis, fracture, infection, tumor resection, and spinal deformities, which require long-segment fusion constructs to the sacrum. The sacral-alar-iliac (SAI) screw technique has been developed as a promising solution to facilitate both minimal invasiveness and strong fixation. The rationale for SAI screw insertion is a medialized entry point away from the ilium and in line with cranial screws. The divergent screw path of the cortical bone trajectory (CBT) provides a higher amount of cortical bone purchase and strong screw fixation and has the potential to harmoniously align with SAI screws due to its medial starting point. However, there has been no report on the combination of these two techniques. The objective of this study was to assess the feasibility of this combination technique. METHODS The subjects consisted of 17 consecutive patients with a mean age of 74.2 ± 4.7 years who underwent posterior lumbosacral fixation for degenerative spinal pathologies using the combination of SAI and CBT fixation techniques. There were 8 patients with degenerative scoliosis, 7 with degenerative kyphosis, 1 with an osteoporotic vertebral fracture at L5, and 1 with vertebral metastasis at L5. Fusion zones included T10-sacrum in 13 patients, L2-sacrum in 2, and L4-sacrum in 2. RESULTS No patients required complicated rod bending or the use of a connector for rod assembly in the lumbosacral region. Postoperative CT performed within a week after surgery showed that all lumbosacral screws were in correct positions and there was no incidence of neurovascular injuries. The lumbosacral bone fusion was confirmed in 81.8% of patients at 1-year follow-up based on fine-cut CT scanning. No patient showed a significant loss of spinal alignment or rod fracture in the lumbosacral transitional region. CONCLUSIONS This is the first paper on the feasibility of a combination technique using SAI and CBT screws. This technique could be a valid option for lumbosacral fixation due to the ease of rod placement with potential reductions in operative time and blood loss.
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Affiliation(s)
- Keitaro Matsukawa
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
| | - Takashi Kato
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
| | - Ralph Mobbs
- 2Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Sydney, Australia
| | - Yoshiyuki Yato
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
| | - Takashi Asazuma
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
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Tavares-Júnior MCM, Sanchez FB, Iturralde JDU, Fernandes RJR, Marcon RM, Cristante AF, de Barros-Filho TEP, Letaif OB. Comparative tomographic study of the iliac screw and the S2-alar-iliac screw in children. Clinics (Sao Paulo) 2020; 75:e1824. [PMID: 32935824 PMCID: PMC7470428 DOI: 10.6061/clinics/2020/e1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.
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Affiliation(s)
- Mauro Costa Morais Tavares-Júnior
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Fernando Barbosa Sanchez
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jaime David Uquillas Iturralde
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Renan Jose Rodrigues Fernandes
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raphael Martus Marcon
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre Fogaça Cristante
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tarcisio Eloy Pessoa de Barros-Filho
- Departamento de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Olavo Biraghi Letaif
- Grupo de Coluna, Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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