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Bryson XM, Pham NS, Hollyer I, Hu S, Rinsky LA, Vorhies JS. 3D CT modeling demonstrates the anatomic feasibility of S1AI screw trajectory for spinopelvic fixation in neuromuscular scoliosis. Spine Deform 2024; 12:933-939. [PMID: 38733488 DOI: 10.1007/s43390-024-00840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/07/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE In patients with neuromuscular scoliosis undergoing posterior spinal fusion, the S2 alar iliac (S2AI) screw trajectory is a safe and effective method of lumbopelvic fixation but can lead to implant prominence. Here we use 3D CT modeling to demonstrate the anatomic feasibility of the S1 alar iliac screw (S1AI) compared to the S2AI trajectory in patients with neuromuscular scoliosis. METHODS This retrospective study used CT scans of 14 patients with spinal deformity to create 3D spinal reconstructions and model the insertional anatomy, max length, screw diameter, and potential for implant prominence between 28 S2AI and 28 S1AI screw trajectories. RESULTS Patients had a mean age of 14.42 (range 8-21), coronal cobb angle of 85° (range 54-141), and pelvic obliquity of 28° (range 4-51). The maximum length and diameter of both screw trajectories were similar. S1AI screws were, on average, 6.3 ± 5 mm less prominent than S2AI screws relative to the iliac crests. S2AI screws were feasible in all patients, while in two patients, posterior elements of the lumbar spine would interfere with S1AI screw insertion. CONCLUSION In this cohort of patients with neuromuscular scoliosis, we demonstrate that the S1AI trajectory offers comparable screw length and diameter to an S2AI screw with less implant prominence. An S1AI screw, however, may not be feasible in some patients due to interference from the posterior elements of the lumbar spine.
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Affiliation(s)
- Xochitl M Bryson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Nicole S Pham
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Ian Hollyer
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Serena Hu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Lawrence A Rinsky
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - John S Vorhies
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA.
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Rahmani R, Stegelmann SD, Andreshak T. S2 alar-iliac screws are superior to traditional iliac screws for spinopelvic fixation in adult spinal deformity: a systematic review and meta-analysis. Spine Deform 2024; 12:829-842. [PMID: 38427156 DOI: 10.1007/s43390-024-00834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/20/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Spinopelvic fixation (SPF) using traditional iliac screws has provided biomechanical advantages compared to previous constructs, but common complications include screw prominence and wound complications. The newer S2 alar-iliac (S2AI) screw may provide a lower profile option with lower rates of complications and revisions for adult spinal deformity (ASD). The purpose of this study was to compare rates of complications and revision following SPF between S2AI and traditional iliac screws in patients with ASD. METHODS A PRISMA-compliant systematic literature review was conducted using Cochrane, Embase, and PubMed. Included studies reported primary data on adult patients undergoing S2AI screw fixation or traditional IS fixation for ASD. Primary outcomes of interest were rates of revision and complications, which included screw failure (fracture and loosening), symptomatic screw prominence, wound complications (dehiscence and infection), and L5-S1 pseudarthrosis. RESULTS Fifteen retrospective studies with a total of 1502 patients (iliac screws: 889 [59.2%]; S2AI screws: 613 [40.8%]) were included. Pooled analysis indicated that iliac screws had significantly higher odds of revision (17.1% vs 9.1%, OR = 2.45 [1.25-4.77]), symptomatic screw prominence (9.9% vs 2.2%, OR = 6.26 [2.75-14.27]), and wound complications (20.1% vs 4.4%, OR = 5.94 [1.55-22.79]). S2AI screws also led to a larger preoperative to postoperative decrease in pain (SMD = - 0.26, 95% CI = -0.50, - 0.011). CONCLUSION The findings from this review demonstrate higher rates of revision, symptomatic screw prominence, and wound complications with traditional iliac screws. Current data supports the use of S2AI screws specifically for ASD. PROSPERO ID CRD42022336515. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Roman Rahmani
- Mercy Health St. Vincent Medical Center, Toledo, OH, USA
| | - Samuel D Stegelmann
- HCA Medical City Healthcare UNT-TCU GME (Denton), 3535 S Interstate 35, Denton, TX, 76210, USA.
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Adhiyaman A, Tracey OC, Zucker C, Wisch J, Widmann RF, Heyer JH. Utilizing robotic-assisted navigation for pelvic instrumentation in pediatric patients with neuromuscular scoliosis: a technical note and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2205-2211. [PMID: 38554164 DOI: 10.1007/s00590-024-03903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
Pelvic fixation is commonly used in correcting pelvic obliquity in pediatric patients with neuromuscular scoliosis and in preserving stability in adult patients with lumbosacral spondylolisthesis or instances of traumatic or osteoporotic fracture. S2-alar-iliac screws are commonly used in this role and have been proposed to reduce implant prominence when compared to traditional pelvic fusion utilizing iliac screws. The aim of this technical note is to describe a technique for robotically navigated placement of S2-alar-iliac screws in pediatric patients with neuromuscular scoliosis, which (a) minimizes the significant exposure needed to identify a bony start point, (b) aids in instrumenting the irregular anatomy often found in patients with neuromuscular scoliosis, and (c) allows for greater precision than traditional open or fluoroscopic techniques. We present five cases that underwent posterior spinal fusion to the pelvis with this technique that demonstrate the safety and efficacy of this procedure.
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Affiliation(s)
- Akshitha Adhiyaman
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Olivia C Tracey
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Colson Zucker
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jenna Wisch
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Roger F Widmann
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Schwend RM, Nguyen BT, Noe MC, Anderson JT, Jiang S. Transiliac-Shortening Osteotomy to Treat Ischial Pressure Injury due to Fixed Pelvic Obliquity: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00031. [PMID: 38758928 DOI: 10.2106/jbjs.cc.23.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
CASE A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely. At the 1-year follow-up visit, there were no further signs of pressure injury. CONCLUSION This case report describes transiliac-shortening osteotomy as a viable treatment option for non-healing ischial pressure injuries secondary to fixed pelvic obliquity.
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Affiliation(s)
- Richard M Schwend
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Brandon T Nguyen
- Kansas City University Graduate Medical Education Consortium (KCU-GME Consortium)/HCA Healthcare Kansas City Program, Kansas City, Missouri
| | - McKenna C Noe
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - John T Anderson
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Shao Jiang
- Department of Plastic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
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Gaumé M, Saghbiny E, Richard L, Thouement C, Vialle R, Miladi L. Pelvic Fixation Technique Using the Ilio-Sacral Screw for 173 Neuromuscular Scoliosis Patients. CHILDREN (BASEL, SWITZERLAND) 2024; 11:199. [PMID: 38397311 PMCID: PMC10887892 DOI: 10.3390/children11020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Pelvic fixation remains one of the main challenging issues in non-ambulatory neuromuscular scoliosis (NMS) patients, between clinical effectiveness and a high complication rate. The objective of this multicenter and retrospective study was to evaluate the outcomes of a technique that was applied to treat 173 NMS patients. The technique is not well-known but promising; it uses the ilio-sacral screw, combined with either the posterior spinal fusion or fusionless bipolar technique, with a minimum follow-up of two years. The mean operative age of the patients was 13 ± 7 years. The mean preoperative main coronal curve was 64° and improved by a mean of -39° postoperatively. The mean preoperative pelvic obliquity was 23°, which improved by a mean of -14° postoperatively. No decrease in the frontal or sagittal correction was observed during the last follow-up. The sitting posture improved in all cases. Twenty-nine patients (17%) had a postoperative infection: twenty-six were treated with local debridement and antibiotics, and three required hardware removal. Fourteen mechanical complications (8%) occurred: screw malposition (n = 6), skin prominence (n = 1), and connector failure (n = 1). This type of surgery is associated with a high risk for infection. Comorbidities, rather than the surgery itself, were the main risk factors that led to complications. The ilio-sacral screw was reliable and effective in correcting pelvic obliquity in NMS patients. The introduction of intraoperative navigation should minimize the risk of screw misplacement and facilitate revision or primary fixation.
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Affiliation(s)
- Mathilde Gaumé
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Netter, 75012 Paris, France; (M.G.); (E.S.); (L.R.); (C.T.)
- Pediatric Orthopedic Surgery Department, Necker Hospital, APHP, University of Paris-Cité, 75015 Paris, France;
| | - Elie Saghbiny
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Netter, 75012 Paris, France; (M.G.); (E.S.); (L.R.); (C.T.)
| | - Lou Richard
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Netter, 75012 Paris, France; (M.G.); (E.S.); (L.R.); (C.T.)
| | - Clélia Thouement
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Netter, 75012 Paris, France; (M.G.); (E.S.); (L.R.); (C.T.)
| | - Raphaël Vialle
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Netter, 75012 Paris, France; (M.G.); (E.S.); (L.R.); (C.T.)
| | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Necker Hospital, APHP, University of Paris-Cité, 75015 Paris, France;
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Shin HK, Park JH, Jeon SR, Roh SW, Jo DJ, Hyun SJ, Cho YJ. Sacropelvic Fixation for Adult Deformity Surgery Comparing Iliac Screw and Sacral 2 Alar-Iliac Screw Fixation: Systematic Review and Updated Meta-Analysis. Neurospine 2023; 20:1469-1476. [PMID: 38171313 PMCID: PMC10762417 DOI: 10.14245/ns.2346654.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Two commonly used techniques for spinopelvic fixation in adult deformity surgery are iliac screw (IS) and sacral 2 alar-iliac screw (S2AI) fixations. In this article, we systematically meta-analyzed the complications of sacropelvic fixation for adult deformity surgery comparing IS and S2AI. METHODS The PubMed, Embase, Web of Science, and Cochrane clinical trial databases were systematically searched until March 29, 2023. The proportion of postoperative complications, including implant failure, revision, screw prominence, and wound complications after sacropelvic fixation, were pooled with a random-effects model. Subgroup analyses for the method of sacropelvic fixation were conducted. RESULTS Ten studies with a total of 1,931 patients (IS, 925 patients; S2AI, 1,006 patients) were included. The pooled proportion of implant failure was not statistically different between the IS and S2AI groups (21.9% and 18.9%, respectively) (p = 0.59). However, revision was higher in the IS group (21.0%) than that in the S2AI group (8.5%) (p = 0.02). Additionally, screw prominence was higher in the IS group (9.6%) than that in the S2AI group (0.0%) (p < 0.01), and wound complication was also higher in the IS group (31.7%) than that in the S2AI group (3.9%) (p < 0.01). CONCLUSION IS and S2AI fixations showed that both techniques had similar outcomes in terms of implant failure. However, S2AI was revealed to have better outcomes than IS in terms of revision, screw prominence, and wound complications.
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Affiliation(s)
- Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong-Jae Cho
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - for the Korean Spinal Deformity Society (KSDS)
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
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Beucler N. Spino-pelvic triangular fixation for unstable U-shaped sacral fractures and Tile C pelvic ring disruptions: The relentless pursuit of vertical, lateral, and anteflexion rotational stability. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100264. [PMID: 37711283 PMCID: PMC10497840 DOI: 10.1016/j.xnsj.2023.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800 Toulon Cedex 9, France
- Ecole du Val-de-Grâce, French Military Health Service Academy, 1 place Alphonse Laveran, 75230 Paris Cedex 5, France
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Beucler N, Tannyeres P, Dagain A. Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review. Asian Spine J 2023; 17:1155-1167. [PMID: 38050362 PMCID: PMC10764139 DOI: 10.31616/asj.2023.0024] [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: 02/07/2023] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 12/06/2023] Open
Abstract
Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure.
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Affiliation(s)
- Nathan Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon,
France
- Ecole du Val-de-Grâce, French Military Health Service Academy, Paris,
France
| | - Paul Tannyeres
- Ecole du Val-de-Grâce, French Military Health Service Academy, Paris,
France
- Orthopaedic Surgery Department, Sainte-Anne Military Teaching Hospital, Toulon,
France
| | - Arnaud Dagain
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon,
France
- Val-de-Grâce Military Academy, Paris,
France
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Geiger F, Eberl J, Wirries A, Forth A, Hammad A. The indication of fusion to the pelvis in neuromuscular scoliosis is based on the underlying disease rather than on pelvic obliquity. 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 2023; 32:4063-4072. [PMID: 37750950 DOI: 10.1007/s00586-023-07943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The decision to instrument to L5 or ilium, in NMS, is usually based on radiologic factors, including pelvic obliquity (PO) > 15°, apex of curvature < L3, and Cobb angle > 60°. Since scoliosis in these patients is caused by a neurologic disease, we based our decision to stop at L5 on the presence of spasticity or flaccidity. PATIENTS & METHODS The senior author did 109 primary fusions in NMS. Of those with DMD or SMA only 16% were instrumented to the ilium. The main factor for our decision was the correction potential of the truncal shift and PO in the supine traction radiographs and the absence of severe spasticity. RESULTS The 57 patients with DMD/SMA had a mean preoperative curvature of 68°, PO of 17°, and truncal shift of 20°. 74% should have been instrumented to the pelvis, but only 16% were. Those instrumented shorter as the rule, were corrected from 74° to 26° and had a postoperative PO of 8°. There was no significant difference in postoperative correction and PO compared to those instrumented to L5 on standard protocol. Subsequent extension to the pelvis was needed in 1 CP patient. There were no significant changes after 2 years. Of the 20 patients instrumented to the pelvis 11 had cerebral palsy and a preop curvature of 89°, a PO of 21° and a truncal shift of 25°. DISCUSSION The decision on instrumentation length should take flexibility and disease into consideration. If the trunk is centred over the pelvis, deterioration will not occur in absence of spasticity.
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Affiliation(s)
- Florian Geiger
- Spine & Scoliosis Center, Hessing Foundation, Augsburg, Germany.
- University Hospital, JW Goethe University, Frankfurt, Germany.
| | - Johanna Eberl
- Spine & Scoliosis Center, Hessing Foundation, Augsburg, Germany
| | - André Wirries
- Spine & Scoliosis Center, Hessing Foundation, Augsburg, Germany
| | - Andreas Forth
- Department for Paediatric Orthopaedic Surgery, Hessing Foundation, Augsburg, Germany
| | - Ahmed Hammad
- Spine & Scoliosis Center, Hessing Foundation, Augsburg, Germany
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Zhao Y, Ma Y, Wang Q, Luo H, Liu J, Lu S. Digital anatomical study and clinical application of the ideal S2 alar-lliac screw trajectory. BMC Surg 2023; 23:301. [PMID: 37794394 PMCID: PMC10552375 DOI: 10.1186/s12893-023-02167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To investigate the ideal trajectory for the S2AI screw and to clinically validate its safety feasibility. METHODS The 3D model was reconstructed from CT data of the pelvis of 30 selected adults, and the 3D coordinate system was established with the first sacral superior endplate as the horizontal plane. A set of cutting planes was made at 3 mm intervals in the coronal plane, and the cross-sectional internal tangent circles were divided in the target area. Using the linear fitting function, the axis of 90 mm length was calculated by the least squares method for each inner tangent circle center. The diameter of the axis is gradually increased until the first contact with the cortex, and the cylindrical model is the ideal screw trajectory. The intersection of the axis and the dorsal cortex is the screw placement point, which is located by Horizon Distance (HD) and Vertical Distance (VD); the diameter of the screw trajectory (d) is the diameter of the cylindrical model; the direction of the screw trajectory is determined by Sagittal Angle (SA) and Transverse Angle (TA). The screw trajectory orientation is determined by Sagittal Angle (SA) and Transverse Angle (TA). Based on the ideal screw trajectory, the 3D printed surgical guide and freehand techniques were used to verify its safety feasibility, respectively. RESULTS The screw placement points [HD (4.7 ± 1.0) mm, VD (19.7 ± 1.9) mm], screw placement directions [SA (31.3°±2.3°), TA (42.4°±2.3°)], and screw dimensions for the ideal screw trajectory of the S2AI were combined for analysis. (L is 90 mm, d is 13.2 ± 1.4 mm). The S2AI screw superiority rate [96.6% (56/58)] and reasonable rate [100%] were higher in the guide group than in the freehand group [90.0% (63/70), 97.1% (68/70)], but the differences were not statistically significant (P > 0.05). Although screws invaded the cortex in both groups, there were no associated adverse events in either group. CONCLUSION The S2AI screw-based ideal trajectory placement is a safe, feasible and accurate method of screw placement.
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Affiliation(s)
- Yonghui Zhao
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming, Xishan District, China
| | - Yulong Ma
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming, Xishan District, China
| | - Qiyang Wang
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming, Xishan District, China
| | - Haotian Luo
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming, Xishan District, China
| | - Jie Liu
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming, Xishan District, China.
| | - Sheng Lu
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, 157 Jinbi Road, Kunming, Xishan District, China.
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Kankam SB, Zarei M, Moghadam N, Jouibari MF, Bazzazi AM, Yaseen Khan FM, Moosavi M, Shafizadeh M, Roohollahi F, Makki BE, Khadivi M, Rostami M. Clinicoradiological Outcomes and Complication Profiles of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screws in Patients with Spinal Deformity Who Underwent Grade 3 or 4 Spinal Osteotomies: A Retrospective Comparative Study. World Neurosurg 2023; 178:e646-e656. [PMID: 37543201 DOI: 10.1016/j.wneu.2023.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To compare short-term clinical and radiological outcomes and complication profiles between bilateral dual sacral-2-alar-iliac (S2AI) screw and bilateral single S2AI screw fixation techniques in patients who underwent grade 3 or 4 spinal osteotomies. METHODS A retrospective review of 83 patients treated with bilateral dual S2AI screws and 32 patients treated with bilateral single S2AI screws was conducted between 2018 and 2020 with a minimum 1-year follow-up. Clinical and radiological outcomes of patients and incidence of perioperative complications, including rod breakage, screw dislodgment, proximal junctional kyphosis, proximal junctional failure, need for reoperation, and systemic adverse effects, were collected and statistically compared between the groups. RESULTS With a mean follow-up of 18.2 months, rod fracture (6.0% vs. 18.7%, P = 0.03), screw dislodgment (0 vs. 12.5%, P < 0.01), and S2AI screw loosening (1.2% vs. 18.7%, P < 0.01) were significantly lower in the dual S2AI screws group than in the single S2AI screws group. However, the reoperation rate was similar between the 2 groups (24.1% vs. 34.3%, P = 0.26). No significant differences in clinical and radiological outcomes as well as proximal junctional kyphosis (10.8% vs. 18.7%, P = 0.25) and proximal junctional failure (9.6% vs. 18.7%, P = 0.18) were identified between the 2 groups. CONCLUSIONS The dual S2AI screw fixation technique showed more advantages over the single S2AI screw fixation technique with reduced incidence of screw dislodgment, rod fractures, and sacral-alar-iliac screw loosening.
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Affiliation(s)
- Samuel Berchi Kankam
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Mohammad Zarei
- Spine Center of Excellence, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedics, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih Jouibari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Bazzazi
- Spine Center of Excellence, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mersad Moosavi
- Spine Center of Excellence, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faramarz Roohollahi
- Spine Center of Excellence, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bassel Eldeen Makki
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khadivi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Spine Center of Excellence, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Spine Center of Excellence, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Park C, Shabani S, Agarwal N, Tan L, Mummaneni PV. Robotic-Assisted Surgery and Navigation in Deformity Surgery. Neurosurg Clin N Am 2023; 34:659-664. [PMID: 37718112 DOI: 10.1016/j.nec.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Deformity surgery is advancing quickly with the use of three-dimensional navigation and robotics. In spinal fusion, the use of robotics improves screw placement accuracy and reduces radiation, complications, blood loss, and recovery time. Currently, there is limited evidence showing that robotics is better than traditional freehand techniques. Most studies favoring robotics are small and retrospective due to the novelty of the technology in deformity surgery. Using these systems can also be expensive and time-consuming. Surgeons should use these advancements as tools, but not rely on them to replace surgical experience, anatomy knowledge, and good judgment.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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13
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Galovich LÁ, Bordón JM, Blanco IC, Peiro A, Mengis CL, Piñera ÁR, Tomé-Bermejo F, Gallego J. Anatomic trajectory for iliac screw placement adapts better to the morphological features of the pelvis of each individual than the S2 alar iliac screw: a radiological study. Acta Neurochir (Wien) 2023; 165:2607-2614. [PMID: 37458861 PMCID: PMC10477215 DOI: 10.1007/s00701-023-05692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The iliac fixation (IF) through the S2 ala permits the minimization of implant prominence and tissue dissection. An alternative to this technique is the anatomic iliac screw fixation (AI), which considers the perpendicular axis to the narrowest width of the ileum and the width of the screw. The morphological accuracy of the iliac screw insertion of two low profile iliac fixation (IF) techniques is investigated in this study. METHODS Twenty-nine patients operated on via low profile IF technique were divided into two groups, those treated using 28 screws with the starting point at S2, and those treated with 30 AI entry point. Radiological parameters (Tsv-angle, Sag-Angle, Max-length, sacral-distance, iliac-width, S2-midline, skin-distance, iliac-wing, and PSIS distance) and clinical outcomes (early and clinic complications) were evaluated by two blinded expert radiologists, and the results were compared in both groups with the real trajectory of the screws placed. RESULTS Differences between ideal and real trajectories were observed in 6 of the 9 evaluated parameters in the S2AI group. In the AI group, these trajectories were similar, except for TSV-Angle, Max-length, Iliac-width, and distance to iliac-wing parameters. Moreover, compared with S2AI, AI provided better adaptation to the pelvic morphology in all parameters, except for sagittal plane angulation, skin distance, and iliac width. CONCLUSIONS AI ensures the advantages of low profile pelvic fixation like S2AI, with a starting point in line with S1 pedicle anchors and low implant prominence, and moreover adapts better to the morphological features of the pelvis of each individual.
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Affiliation(s)
- Luis Álvarez Galovich
- Unidad de Patología de Columna, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Julia Montoya Bordón
- Servicio de Radiodiagnostico, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Irantzu Castelbon Blanco
- Servicio de Patología de Columna, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Avda. Reyes Católicos, 28040 Madrid, Spain
| | - Alejandro Peiro
- Unidad de Patología de Columna, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Charles Louis Mengis
- Unidad de Patología de Columna, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Ángel R. Piñera
- Unidad de Patología de Columna, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Félix Tomé-Bermejo
- Universidad Autónoma de Madrid, Faculty of Medicine and Surgery, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Jesus Gallego
- Unidad de Patología de Columna, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
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14
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Kankam SB, Zarei M, Moghadam N, Jouibari MF, Bazzazi AM, Yaseen Khan FM, Moosavi M, Shafizadeh M, Roohollahi F, Makki BE, Khadivi M, Rostami M. Clinicoradiological Outcomes and Complication Profiles of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screws in Patients with Spinal Deformity Who Underwent Grade 3 or 4 Spinal Osteotomies: A Retrospective Comparative Study. World Neurosurg 2023. [DOI: https:/10.1016/j.wneu.2023.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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15
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Kankam SB, Zarei M, Moghadam N, Jouibari MF, Bazzazi AM, Yaseen Khan FM, Moosavi M, Shafizadeh M, Roohollahi F, Makki BE, Khadivi M, Rostami M. Clinicoradiological Outcomes and Complication Profiles of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screws in Patients with Spinal Deformity Who Underwent Grade 3 or 4 Spinal Osteotomies: A Retrospective Comparative Study. World Neurosurg 2023. [DOI: https:/doi.org/10.1016/j.wneu.2023.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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16
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Vahedi P, Shabakhsh G, Monji F. Software-assisted preoperative planning of S1 Alar Iliac screws: a 3D morphometric and anatomical study. 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 2023; 32:2274-2281. [PMID: 37179257 DOI: 10.1007/s00586-023-07741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/08/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE S1 alar iliac (S1AI) trajectory has gained popularity as a salvage technique for revision surgeries and failed constructs in the lumbopelvic region. This study aims to investigate the morphometry of this new trajectory based on 3D models. The possible role of gender, ethnicity and view angle (surgeon's vs. radiologist's) was investigated. METHODS Computed tomography-driven virtual 3D models of spinopelvic region were created applying Materialize MIMICS software, and assessed for coronal and sagittal radiographic versus surgeon's view angles, and morphometry of the screw trajectory. Independent-samples t test was used to analyze the results. P value was set at < = 0.05. The Statistical Package for the Social Sciences Software (SPSS version 24.0) was used for the statistical analysis. RESULTS A total of 164 3D models were simulated with a total 328 screws inserted satisfactorily within the S1AI trajectory. S1AI instrumentation was feasible in 96.48%. The mean radiological coronal angle was 50.619' ± 8.590' and the mean coronal angle for surgeons' perspective was 10.263' ± 5.860'. The mean radiological and surgeon's perspective sagittal angles were found to be 44.532' ± 6.424' and 31.164' ± 5.455', respectively. A statistically significant difference was found between anatomical and surgeon's perspective trajectories. Neither the pelvic laterality nor the gender influence the screw angles, length and diameter in radiological versus surgeon's view angles. CONCLUSION Preoperative 3D modeling would be an invaluable adjunct to increase the accuracy of S1AI screw placement. Surgeon's perspective of the trajectory differs from standard CT sections and should be considered in preoperative planning.
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Affiliation(s)
- Payman Vahedi
- Department of Neurosurgery, Tehran Medical Branch, Farhikhtegan Hospital, Islamic Azad University, Tehran, Iran.
- Tehran Medical Branch, Bou-Ali Research Center, Islamic Azad University, Tehran, Iran.
- Department of Neurosurgery, Tehran Medical Branch, Bou-Ali Hospital, Islamic Azad University, Tehran, Iran.
| | - Ghazal Shabakhsh
- Tehran Medical Branch, Bou-Ali Research Center, Islamic Azad University, Tehran, Iran
- Department of Neurosurgery, Tehran Medical Branch, Bou-Ali Hospital, Islamic Azad University, Tehran, Iran
| | - Faeze Monji
- Tehran Medical Branch, Bou-Ali Research Center, Islamic Azad University, Tehran, Iran
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17
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Zhang W, Cheng Y, Diarra MD, Chen E, Hou W, Xin Z, Pan Z, Li W. Finite element analysis of sacral-alar-iliac screw fixation for sacroiliac joint dislocation. J Orthop Res 2023. [PMID: 36691867 DOI: 10.1002/jor.25525] [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: 10/05/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
The percutaneous sacroiliac (SI) screw is a common fixation option for posterior ring disruption in pelvic fractures. However, SI screw placement is difficult and can injure adjacent neurovascular structures. The sacral-alar-iliac screw (SAI) is a safe, reliable free-hand sacral pelvic fixation technique. To investigate the biomechanical stability of SAI for SI joint dislocation, finite element analysis was performed in unstable Tile-Type B and C pelvic ring injuries. The displacement in S1 (fixation of a unilateral S1 segment with one SI screw), TS1 (fixation of the S1 segment with a transsacra 1 screw), TS2 (fixation of the S2 segment with a transsacra 2 screw), S1AI, and S2AI exceeded the normal SI joint mobility. Sufficient stability after SI joint dislocation was obtained with (TS1 + TS2), (TS2 + S1), (S1AI + S2AI + rod), (S1AI + S2AI), and (S1 + S2AI + S1 pedicle) fixation. The TS1 + TS2 group had the smallest displacement and lowest peak screw stress, followed by (S1 + S2AI + S1 pedicle) placement. Our findings suggest that SAI screws are a valuable option for SI joint dislocation.
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Affiliation(s)
- Wei Zhang
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Yucheng Cheng
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Mohamed Diaty Diarra
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Erman Chen
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Weiduo Hou
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Zengfeng Xin
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Zhijun Pan
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
| | - Weixu Li
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Research Institute of Orthopedics, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, PR China
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18
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Youssef EM. Sacropelvic fixation. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-022-00182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractThe sacropelvis is not only an anatomically complex region but also a biomechanically unique zone transferring axial weights via the transitional lumbosacral junction and the pelvic girdle to the lower appendicular skeleton. When the sacral instrumentation alone is insufficient to achieve stability and solid arthrodesis across the lumbosacral junction, as in long-segment fusions, high-grade spondylolisthesis, deformity corrections, complex sacral/lumbosacral injuries, and neoplasms, sacropelvic fixation is indicated. Many modern sacropelvic fixation modalities outperform historical modalities, especially the conventionally open and percutaneous iliac and S2-alar-iliac screw (S2AI) fixation techniques. Novel screw insertion technologies such as navigation and robotics and modern screw designs aim to maximize the accuracy of screw placement and minimize complications. This review addresses the anatomy and biomechanics of the sacropelvic region as well as the indications, evolution, advantages, and disadvantages of various past and contemporary techniques of lumbosacral and sacropelvic fixation.
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19
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Watanabe N, Takigawa T, Uotani K, Oda Y, Misawa H, Tanaka M, Ozaki T. Three-Dimensional Analysis of the Ideal Entry Point for Sacral Alar Iliac Screws. Asian Spine J 2022; 16:874-881. [PMID: 35184519 PMCID: PMC9827214 DOI: 10.31616/asj.2021.0268] [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: 07/06/2021] [Accepted: 10/17/2021] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN This is a virtual three-dimensional (3D) imaging study examining computed tomography (CT) data to investigate instrumentation placement. PURPOSE In this study, we aim to clarify the ideal entry point and trajectory of the sacral alar iliac (SAI) screw in relationship to the dorsal foramen at S1 and the respective nerve root. OVERVIEW OF LITERATURE To the best of our knowledge, there is yet no detailed 3D imaging study on the ideal entry point of the SAI screw. Despite the evidence suggesting that the dorsal foramen at S1 is a landmark on the sacrum, the S1 nerve root disruption is a general concern during the insertion of SAI screws. No other study has been published examining the nerve root location at the S1and SAI screw insertions. METHODS Preoperative CT data from 26 patients pertaining to adult spinal deformities were investigated in this study. We applied a 3D image processing method for a detailed investigation. Virtual cylinders were used to mimic SAI screws. These were placed to penetrate the sacral iliac joint without violating the other cortex. We then assessed the trajectory of the longest SAI screw and the ideal entry point of SAI using a color mapping method on the surface of the sacrum. We measured the location of the nerve root at S1 in relation to the foramen at S1 and the sacral surface. RESULTS As per the results of our color mapping, it was determined that areas that received high scores are located medially and caudally to the dorsal foramen of S1. The mean angle between a horizontal line and a line connecting the medial edge of the foramen and nerve root at S1 was 93.5°. The mean distances from the dorsal medial edge of the foramen and sacral surface to S1 nerve root were 21.8 mm and 13.9 mm, respectively. CONCLUSIONS The ideal entry point of the SAI screw is located medially and caudally to the S1 dorsal foramen based on 3D digital mapping. It is also shown that this entry point spares the S1 nerve root from possible iatrogenic injuries.
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Affiliation(s)
- Noriyuki Watanabe
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan,Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi,
Japan
| | - Tomoyuki Takigawa
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan,Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe,
Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan,Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama,
Japan
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan
| | - Haruo Misawa
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan,Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama,
Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama,
Japan
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20
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Hirase T, Shin C, Ling J, Phelps B, Haghshenas V, Saifi C, Hanson DS. S2 alar-iliac screw versus traditional iliac screw for spinopelvic fixation: a systematic review of comparative biomechanical studies. Spine Deform 2022; 10:1279-1288. [PMID: 35763199 DOI: 10.1007/s43390-022-00528-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To review and compare biomechanical properties between S2 alar-iliac (S2AI) screws and traditional iliac screws for spinopelvic fixation. METHODS A systematic review was performed according to PRISMA guidelines. All clinical, cadaveric, and finite-element model (FEM) studies that compared the biomechanical properties between S2AI screws and traditional iliac screws were included. Study methodological quality for cadaveric studies were analyzed using the Quality Appraisal for Cadaveric Studies (QUACS) scale. RESULTS Eight studies (4 cadaveric, 4 FEM) analyzing 58 S2AI screws and 48 traditional iliac screws were included. According to QUACS, the overall methodological quality was "moderate to good" for all four cadaveric studies. All four cadaveric studies found no difference in biomechanical stiffness, screw toggle, rod strain, and/or load-to-failure between the S2AI screws and traditional iliac screws for spinopelvic fixation. All four FEM studies found that S2AI screws were associated with lower implant stresses compared to traditional iliac screws. CONCLUSIONS There is moderate biomechanical evidence to suggest that there is no significant difference in stability and stiffness between S2AI screws and traditional iliac screws for spinopelvic fixation. However, there is some evidence to support that the placement of S2AI screws may have lower implant stresses on the overall lumbosacral instrumentation compared to traditional iliac screws.
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Affiliation(s)
- Takashi Hirase
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA.
- Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
| | - Caleb Shin
- Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA
| | - Jeremiah Ling
- Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA
| | - Brian Phelps
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA
| | - Varan Haghshenas
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA
| | - Comron Saifi
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA
| | - Darrell S Hanson
- Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA
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21
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Kassab Hassan S, Simon L, Campana M, Julien-Marsollier F, Simon AL, Ilharreborde B. S2-Alar-iliac screw fixation for paediatric neuromuscular scoliosis: Preliminary results after two years. Orthop Traumatol Surg Res 2022; 108:103234. [PMID: 35144011 DOI: 10.1016/j.otsr.2022.103234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Correcting pelvic obliquity is among the main goals of surgery for neuromuscular scoliosis. Spino-pelvic fixation must be stable and capable of withstanding the considerable mechanical forces applied at the lumbo-sacral junction. Selection of the best anchoring option is therefore crucial. S2-alar-iliac (S2AI) screws, which are used in adults, are less often chosen in the French paediatric spinal-surgery community. The objective of this study was to report our preliminary experience with S2AI screws used in the treatment of paediatric patients with neuromuscular scoliosis. HYPOTHESIS Pelvic anchoring by means of S2AI screws is reliable and technically feasible in non-ambulatory children with neuromuscular scoliosis. MATERIALS AND METHODS Consecutive non-ambulatory patients who underwent scoliosis surgery with S2AI screw fixation to the pelvis between 2016 and 2018 were retrospectively included. The surgical procedure consisted in either posterior spinal fusion (PSF) or magnetic growing rod (MGR) implantation. In all patients, radiographs were obtained before surgery, within 3 months after surgery, and at last follow-up; and low-dose computed tomography (CT) was performed before and after surgery. RESULTS We included 25 patients with a mean age of 13.8±4.0 years, 18 managed by PSF and 7 by MGRs. Screw diameters ranged from 7.5 to 9.5mm and all screws were at least 60mm in length. The diameters and lengths were the same on both sides in 16 (89%) patients in the PSF group and in all patients in the MGR group. At last follow-up after a mean of 35.5±3.0 months, pelvic obliquity was corrected in all 23 patients with this abnormality before surgery. Complications consisted of lateral cortical screw breakthrough in 8 (32% of screws) patients and screw malposition in 2 (8% of screws) patients. No clinically significant complications related to the fixation material were recorded. DISCUSSION The results of our study demonstrate the feasibility of S2AI screw fixation in paediatric patients with neuromuscular scoliosis. Pelvic asymmetry and dysmorphism do not contra-indicate the procedure but must be evaluated before surgery. Further work is needed to assess the potential long-term consequences on pain and growth of screw passage through the sacro-iliac joints. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Sammy Kassab Hassan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Laurie Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Matthieu Campana
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d'anesthésie - réanimation pédiatrique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France.
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
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22
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Huang W, Xu L, Cai W, Cheng M, Sun Z, Wang S, Yan W. Freehand S2-Alar-Iliac Screw Placement Technique in Lumbosacral Spinal Tumors: A Preliminary Study. Orthop Surg 2022; 14:2195-2202. [PMID: 35975359 PMCID: PMC9483049 DOI: 10.1111/os.13434] [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: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE S2-alar-iliac (S2AI) screw technique is widely used in spinal surgery, but it is rarely seen in the field of spinal tumors. The aim of the study is to report the preliminary outcomes of the freehand S2AI screw fixation after lumbosaral tumor resection. METHODS The records of patients with lumbosacral tumor who underwent S2AI screw fixation between November 2016 to November 2020 at our center were reviewed retrospectively. Outcome measures included operative time, blood loss, complications, accuracy of screws, screw breach, and overall survival. Mean ± standard deviation or range was used to present continuous variables. Kaplan-Meier curve was used to present postoperative survival. RESULTS A total of 23 patients were identified in this study, including 12 males and 11 females, with an average age of 47.3 ± 14.5 (range,15-73). The mean operation time was 224.6 ± 54.1 (range, 155-370 min). The average estimated blood loss was 1560.9 ± 887.0 (600-4000 ml). A total of 46 S2AI screws were implanted by freehand technique. CT scans showed three (6.5%) screws had penetrated the iliac cortex, indicating 93.5% implantation accuracy rate. No complications of iatrogenic neurovascular or visceral structure were observed. The average follow-up time was 31.6 ± 15.3 months (range, 13-60 months). Two patients' postoperative plain radiography showed lucent zone around the screw. One patient underwent reoperation for wound delayed infection. At the latest follow-up, eight patients had tumor-free survival, 11 had survival with tumor, and four died of disease. CONCLUSION The freehand S2AI screw technique is reproducible, safe, and reliable in the management of lumbosacral spinal tumors.
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Affiliation(s)
- Wending Huang
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lun Xu
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiluo Cai
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mo Cheng
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengwang Sun
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Shanghai Cancer Center, Fudan University
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Mun F, Vankara A, Suresh KV, Margalit A, Kebaish KM, Sponseller PD. Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up. J Pediatr Orthop 2022; 42:e709-e712. [PMID: 35575763 DOI: 10.1097/bpo.0000000000002187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up. METHODS We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections. RESULTS Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications. CONCLUSIONS SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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24
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Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery. Spine (Phila Pa 1976) 2022; 47:986-994. [PMID: 35819333 DOI: 10.1097/brs.0000000000004356] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/05/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort review of a prospective multicenter database. OBJECTIVE Identify rates and variations in lumbopelvic fixation failure after adult spinal deformity (ASD) correction. SUMMARY OF BACKGROUND DATA Traditional iliac (IS) and S2-alar-iliac (S2AI) pelvic fixation methods have unique technical characteristics for their application, and result in varied bio-mechanical and anatomic impact. These differences may lead to variance in lumbopelvic fixation failure types/rates. METHODS ASD patients undergoing correction with more than five level fusion and pelvic fixation, separated by pelvic fixation type (IS vs. S2AI). Fixation fracture or loosening assessed radiographically (Figure 1). Multivariate logistic regression, accounting for significant confounders, was used to examine differences between the two groups for screw loosening/fracture, rod fracture, and revision surgery. Level of significance set at P< 0.05. RESULTS Four hundred eighteen of 1422 patients were included (IS = 287, S2AI = 131). The groups had similar age, body mass index (BMI), baseline comorbidities, number of levels fused (P>0.05), baseline health related quality of life measures (HRQLs) (short form survey-36, Oswestry Disability Index [ODI], Scoliosis Research Society [SRS-22], numeric rating scale [NRS] leg and back, P>0.05) and deformity (pelvic tilt [PT], pelvic incidence-lumbar lordosis [PI-LL], and sagittal vertical axis [SVA], P> 0.05). The IS group had more unilateral fixation versus S2AI (12.9% vs. 6%; P = 0.02). The overall lumbopelvic fixation failure rate was 23.74%. Pelvic fixation (13.4%) and S1 screw (2.9%) loosening was more likely with S2AI (odds ratio [OR] 2.63, P = 0.001; OR 6.05, P = 0.022). Pelvic screw (2.3%) and rod fracture (14.1%) rates similar between groups but trended toward less occurrence with S2AI (OR 0.47, P= 0.06). Revision surgery occurred in 22.7%, and in 8.5% for iliac fixation specifically, but with no differences between fixation types (P = 0.55 and P = 0.365). Pelvic fixation failure conferred worse HRQL scores (physical component score [PCS] 36.23 vs. 39.37, P= 0.04; ODI 33.81 vs. 27.93, P = 0.036), and less 2 years improvement (PCS 7.69 vs. 10.46, P = 0.028; SRS 0.83 vs. 1.03, P = 0.019; ODI 12.91 vs. 19.77, P = 0.0016). CONCLUSION Lumbopelvic fixation failure rates were high following ASD correction, and associated with lesser clinical improvements. S2AI screws were more likely to demonstrate loosening, but less commonly associated with rod fractures at the lumbopelvic region.
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Brown NJ, Shahrestani S, Kurtz JS, Beyer RS, Pham MH, Osorio J. Successful use of stereotactic navigation in posterior spinal fusion T10-S2 with bilateral iliac screw fixation in a patient with prior spinal surgeries and osteoporosis: A case report. Int J Surg Case Rep 2022; 97:107380. [PMID: 35839654 PMCID: PMC9403018 DOI: 10.1016/j.ijscr.2022.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Degenerative lumbar scoliosis is a prominent cause of adult spinal deformity with an increasing prevalence as the population ages. This pathology is associated with debilitating symptoms, including radicular back pain and lower extremity claudication. Surgical realignment of the spine and restoration of sagittal imbalance can reduce low back pain. Chronic sacroiliac dysfunction commonly causes low back radicular pain. We present a complicated case where stereotactic navigation facilitated an extensive fusion and decompression procedure for adult spinal deformity in an obese patient with multiple prior surgeries for scoliosis and sacroiliac joint pathology. CASE PRESENTATION A 69-year-old, obese female with scoliosis refractory to multiple interventions presented with severe, radicular lower back pain. On examination of the right lower extremity (RLE), she had mild weakness (3/5 strength) and reduced sensation to light touch over its anterolateral aspect (dermatome L4). She was unable to perform single leg stance or tandem walk. Imaging revealed moderate mid-lumbar levoscoliosis, severe degenerative disc disease and facet hypertrophy changes in the setting of prior multilevel lumbar fusion, and consecutive nerve root impingement between L1 and L5 (worst at L3-4). DEXA scan was consistent with osteoporosis. The patient underwent lumbar laminectomy with posterior fusion of T10-ilium, transforaminal lumbar interbody fusion, osteotomy, and decompression using stereotactic navigation. The presence of SI titanium dowels from her previous SI fusion procedure posed a challenge with respect to achieving pelvic fixation. CLINICAL DISCUSSION Iliac screw placement is a critical adjunctive to lumbosacral fusion, notably for prevention of pseudoarthrosis; however, patients with prior SI fusion may present a biomechanical challenge to surgeons due to obstruction of the surgical site. The O-arm neuronavigation system was successfully used to bypass this obstruction and provide sacroiliac fixation in this procedure. CONCLUSION Stereotactic navigation (The O-arm Surgical Imaging System) can effectively be used to circumvent prior SI fusion in osteoporotic bone.
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Affiliation(s)
- Nolan J. Brown
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA,Corresponding author at: UC Irvine Department of Neurosurgery, 101 The City Drive South, Orange, CA 92868, USA.
| | - Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Mechanical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Joshua S. Kurtz
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA
| | - Ryan S. Beyer
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA
| | - Martin H. Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Joseph Osorio
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
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Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Segi N, Ouchida J, Kagami Y, Ando K, Kobayashi K, Imagama S. Sacroiliac Joint Degeneration After Lumbopelvic Fixation. Global Spine J 2022; 12:1158-1164. [PMID: 33375856 PMCID: PMC9210252 DOI: 10.1177/2192568220978235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Study. OBJECTIVES Sacroiliac buttress screws (SBS) and S2 alar iliac screws (SAI) are used as distal screws in cases with long fusion to the pelvis. Distal fixation ends, whether exceeding the sacroiliac joint (SIJ), may affect postoperative degenerative changes in the SIJ. The aim of this study was to investigate SIJ degeneration after lumbosacral and lumbopelvic fixation, using SBS and SAI in degenerative spine diseases, respectively. METHODS This study included 70 patients aged ≥50 years with lumbosacral fusion (>3 levels). They were divided into 2 groups (SBS 20 and SAI 50 cases) based on the type of distal screws. Radiographical and clinical data were reviewed with a minimum 2-year follow-up. Radiographical SIJ degeneration was analyzed using computed tomography; clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ). RESULTS No significant differences were observed in patients' preoperative characteristics between the 2 groups. The incidence of SIJ degeneration, including osteophyte formation (30.0% and 8.0%, p = 0.03), intraarticular air (75.0% and 16.0%, p < 0.001), and subchondral cyst (20.0% and 2.0%. p = 0.02) in SBS and SAI groups, respectively, at the follow-up, was significantly higher in the SBS group. Although SIJ degenerative changes were significantly different between the SBS and SAI groups, there was no significant difference in VAS and JOABPEQ scores between the groups at 2 years post-surgery. CONCLUSIONS Lumbosacral fusion can cause SIJ degeneration, which is more frequent when SBS are used in fixation to the sacrum.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Aichi, Japan,Hiroaki Nakashima, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Aichi, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Aichi, Japan
| | - Yujiro Kagami
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Aichi, Japan
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Pelvic fixation is not always necessary in children with cerebral palsy scoliosis treated with growth-friendly instrumentation. Spine Deform 2022; 10:925-932. [PMID: 35066795 DOI: 10.1007/s43390-022-00474-z] [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: 09/11/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE A previous study showed that patients with neuromuscular scoliosis who underwent fusion to L5 had excellent coronal curve correction and improvement in pelvic obliquity (PO) when preoperative L5 tilt was < 15°. Our purpose was to identify indications to exclude the pelvis in children with cerebral palsy (CP) scoliosis treated with growing-friendly instrumentation. METHODS In a retrospective cohort study, children with CP scoliosis treated with TGR, MCGR, or VEPTR with minimum 2-year follow-up were identified from a multicenter database. RESULTS 27 patients with distal spine anchors (DSA) and 71 patients with distal pelvic anchors (DPA) placed at the index surgery were analyzed. The DSA group had a lower pre-index PO (9° vs 16°, P = 0.0001). Most recent radiographic data were similar except the DSA patients had a smaller major curve (47° vs 58°, P = 0.038). 6 (22%) DSA patients underwent extension of the instrumentation to the pelvis (DSA-EXT), most commonly at final fusion (5 patients). DSA-EXT patients had a higher pre-index L5 tilt than patients who did not require extension (DSA-NO EXT) (19° vs 10°, P = 0.009). Sub-analysis showed a lower major curve at most recent follow-up in the DSA-EXT group compared to the DPA group (33° vs 58°, P = 0.021). The DSA-EXT group had a higher number of complications per patient compared to the DSA-NO EXT group (2.3 vs 1.1, P = 0.029). CONCLUSION Pre-index L5 tilt ≤ 10° and PO < 10° may be indications to exclude the pelvis in children with CP scoliosis treated with growth-friendly instrumentation. DSA may provide better long-term control of the major curve than DPA.
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Pelvic fixation in surgical correction of neuromuscular scoliosis. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100123. [PMID: 35619626 PMCID: PMC9126953 DOI: 10.1016/j.xnsj.2022.100123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022]
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Three-dimensional digital anatomical measurement of modified sacroiliac screws. J Orthop Surg Res 2022; 17:136. [PMID: 35246196 PMCID: PMC8896299 DOI: 10.1186/s13018-022-03018-3] [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: 01/06/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To rebuild a model of the pelvis and effectively simulate the trajectory of modified sacroiliac screws, we measured the parameters of each screw and screw channel and assessed the safety and feasibility of the parameters in adults. Method and materials One hundred (50 males and 50 females) normal adult pelvic computed tomography (CT) images were randomly selected and imported into Mimics software to rebuild the three-dimensional pelvis model. In these models, each ideal channel of modified screws was simulated, and then we obtained the precise parameters of screws and channels using Mimics and Three-matic software. Results The results of the comparison (right vs. left) showed that there were no significant differences in any of the angles, radius or M1SI parameters (the first modified sacroiliac). However, one parameter (BS) of M2SI (the second modified sacroiliac), two parameters (AP and BS) of M3SI (the third modified sacroiliac), and three parameters (AP, BS, L) of M4SI (the fourth modified sacroiliac) were statistically significant (P < 0.05). The result of comparison (between genders) showed that there were no significant differences in M1SI and M2SI; in contrast, the radius, length and the α angle of M3SI and M4SI were significantly different between genders (P < 0.05), and the radius of M4SI required special attention. If the radius of the limiting screw channel was > 3.50 mm, 52 cases (52%, 24 males and 28 females) could not complete the M4SI screw placement among 100 samples. If the radius of the limiting screw channel was > 3.0 mm, a total of 10 cases (10%, 2 males and 8 females) could not complete the M4SI screw placement. Conclusion Through the measurement of 100 healthy adult real three-dimensional pelvic models, we obtained the parameters of each modified sacroiliac screw and measured the three angles of each screw based on international coordinates for the first time, which can instruct clinical application.
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30
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Zhong XL, Qian BP, Huang JC, Wang B, Qiu Y. Does the thoracolumbar kyphosis secondary to ankylosing spondylitis affect the iliac trajectory of S2AI screw? BMC Musculoskelet Disord 2022; 23:194. [PMID: 35236320 PMCID: PMC8889681 DOI: 10.1186/s12891-022-05140-z] [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: 10/26/2021] [Accepted: 02/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background The study aimed to evaluate the influence of thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) on parameters of S2AI trajectory and to compare the ideal S2AI trajectory with those of the non-deformity patients with AS, sagittal deformity patients without AS, and the normal population reported in literatures. Methods Sagittal parameters including global kyphosis (GK), pelvic tilt (PT) and sacral slope (SS) were measured. Besides, according to the simulated ideal S2AI trajectory on the CT images, trajectory parameters were measured including Sag angle, Tsv angle, Max-length, Sacral distance and Iliac width. Starting-point parameters were also measured including PSIS distance, Skin distance, Iliac wing and S2 midline. Results Ninety-four AS-related thoracolumbar kyphosis patients were included. After adjusting the age and gender, twenty non-deformity patients with AS and 20 sagittal deformity patients without AS were selected to compare with patients with AS-related thoracolumbar kyphosis, respectively. Sag angle in deformity patients with AS was smaller than other two groups (P < 0.001). No difference was found in Tsv angle and Sacral distance between AS patients with and without deformity. However, these two parameters were shown significant differences between deformity patients with AS and without AS. In deformity patients with AS, no significant differences were found in all parameters between genders Furthermore, there were strong correlations between PT and the bilateral Sag angle (P < 0.001). Conclusions The thoracolumbar kyphosis secondary to AS affects the Sag angle of the ideal S2AI trajectory which was approximately 20° smaller than that in non-deformity patients with AS, sagittal deformity patients without AS, and the normal population. Additionally, the Tsv angle and the Sacral distance in AS patients with thoracolumbar kyphosis were about 10° and 10 mm larger than those in sagittal deformity patients without AS, and the normal population reported in literatures.
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Affiliation(s)
- Xiao-Lin Zhong
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.,Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Ji-Chen Huang
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.,Medical School of Nanjing University, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
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Xu F, Zhou S, Zou D, Li W, Sun Z, Jiang S. The relationship between S1 screw loosening and postoperative outcome in patients with degenerative lumbar scoliosis. BMC Musculoskelet Disord 2022; 23:186. [PMID: 35227237 PMCID: PMC8883643 DOI: 10.1186/s12891-022-05107-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background When choosing S1 as the lowest level of instrumentation, there are many complications may come out such as S1 screw loosening. Facing this problem, there has been various techniques for the protection of S1 screw including sacropelvic fixation, bicortical or tricortical insertion of S1 screw. Objective This study aimed to explore the risk factors for the S1 screw loosening, then to demonstrate the relationship between S1 screw loosening and postoperative outcome for patients with degenerative lumbar scoliosis (DLS). Methods Patients who underwent lumbosacral fixation for DLS were evaluated retrospectively. They were divided into two groups according to the S1 pedicle screw at the follow-up. Age, gender, bone mineral density, body mass index, history of smoking, the number of instrumented levels, comorbidities, complications and radiological parameters were collected. We established logistic regression analysis to determine independent risk factors for S1 screw loosening and multiple linear regression to identify whether S1 screw loosening would influence postoperative clinical outcome. Results S1 screw loosening rate was up to 41.0% (32/78). Patients were older in the S1 screw loosening group than those in the control group (P < 0.05). Compared with the control group, the rate of osteoporosis was higher in screw loosening group than that in the control group (P < 0.05). Older age and osteoporosis were independent risk factors for S1 screw loosening (P < 0.05). In the screw loosening group, the rate of hypertension was higher than that in the control group (P < 0.05). The relationship of S1 screw loosening and ODI was not significant in the multiple linear regression (P > 0.05). The clinical outcome was similar in the S1 screw loosening group and control group (P > 0.05). Conclusion Older age and osteoporosis are independent risk factors for the S1 screw loosening. Patients with complication of S1 screw loosening are not always along with worse clinical outcome. We should consider potential benefit, complications and medical cost when choosing the lowest instrumented vertebrae for patients with DLS.
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Affiliation(s)
- Fei Xu
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Siyu Zhou
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Da Zou
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China.
| | - Zhuoran Sun
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
| | - Shuai Jiang
- Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.,Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Reasearch, Beijing, China
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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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Zhou Z, Tu C, Yu H, Xiong J, Liu Z, Ma S, Deng W, Cao K. Ball Tip Technique for S2AI Screw Placement in Sacropelvic Fixation: A Comparative Study with Conventional Freehand Technique. Orthop Surg 2022; 14:389-396. [PMID: 34978154 PMCID: PMC8867419 DOI: 10.1111/os.13196] [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: 08/20/2020] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the efficiency of the ball tip technique for S2AI screw placement and introduce this technique. Methods Sixty‐three patients who underwent pelvic fixation with S2AI screws were retrospectively reviewed. They were 29 males and 34 females with an average age of 59.6 ± 12.5 years. Among these patients, 35 patients (14 males and 21 females with an average age of 58.8 ± 11.3 years) received ball tip technique and 28 patients (15 males and 13 females with an average age of 63.7 ± 12.6 years) received conventional freehand technique. Ball tip technique was used in ball tip technique group. After a pedicle probe just penetrated the sacroiliac joint, a ball‐tipped probe consisting of a ball shaped metal tip with a flexible shaft was malleted to make a guide track within ilium. This ball‐tipped probe could bend automatically away from the cortex and forward through the cancellous bone when the tip met the cortical lamina of ilium, which can avoid penetration. After repeating the procedures, a guide hole was gradually formed. S2AI screw was inserted along the guide hole after tapping. In the conventional freehand group, S2AI screw was placed according to the conventional method. Postoperative computed tomography (CT) was used to assess the accuracy of screws. The time cost of screw insertion and screw‐related complications were recorded. Independent t‐test was used to compare the time cost between ball tip group and conventional freehand group. A chi‐square test was used to compare the accuracies of the ball tip group with the conventional group. Results There were 35 patients (70 S2AI screws) in ball tip group and 28 patients (56 S2AI screws) in conventional freehand group. No screw‐related complication occurred in all patients. Time costs were 9.8 ± 4.5 mins in ball tip group and 20.2.0 + 8.6 mins in conventional freehand group, respectively (P < 0.05). Four screws penetrated iliac cortex in the ball tip group vs 10 screws in conventional freehand group (5.7% vs 17.9%) (P < 0.05). Conclusions The ball tip technique enhances the accuracy of screw placement and has less time cost compared with conventional freehand technique.
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Affiliation(s)
- Zhenhai Zhou
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng Tu
- Lushan Convalescent Center and Clinic of People's Liberation Army of China, Jiujiang, China
| | - Honggui Yu
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiachao Xiong
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhiming Liu
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengbiao Ma
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenqiang Deng
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai Cao
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Zheng J, Xiang J, Zheng J, Feng X, Chen B. Treatment of Unstable Posterior Pelvic Ring Injury with S2-Alar-Iliac Screw and S1 Pedicle Screw Fixation. World Neurosurg 2021; 158:e1002-e1010. [PMID: 34896346 DOI: 10.1016/j.wneu.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The S2-alar-iliac (S2AI) screws have been described as an alternative method for lumbosacropelvic fixation in place of iliac screws. However, the clinical effect of the short-segment S2AI screw fixation technique in the treatment of unstable posterior pelvic ring injuries remains unclear. In this study, we report the preliminary clinical results of the internal fixation connecting a S2-alar-iliac screw and a S1 pedicle screw (i.e., S2AI-S1 fixation) in the treatment of unstable pelvic posterior ring injuries. METHODS Twenty-five patients with unstable posterior pelvic ring injury were treated with S2AI-S1 fixation from February 2019 to June 2020. The incision length, surgical time, blood loss, frequency of intraoperative fluoroscopy, quality of reduction, complications, and functional outcome were analyzed. RESULTS A total of 29 groups of S2AI-S1 fixation were used in 25 patients. The mean incision length was 8.3 (6.2 - 10.3) cm, mean operative time was 86.4 (60 - 142) minutes, mean frequency of intraoperative fluoroscopy was 7.9 (4 - 12) times, and mean blood loss was 148 (50 - 500) mL. The mean postoperative follow-up time was 17.8 (10 - 26) months. The satisfaction rate of pelvic reduction quality was 25/29, and the satisfactory rate of functional outcome was 23/25. There were no obvious signs of screw prominence, screw loosening, or implant failure. CONCLUSIONS The case series presented in this study show the successful use of S2AI-S1 fixation to treat unstable posterior pelvic ring injuries. The S2AI-S1 fixation, not including the lumbar spine in the fixation range, is a simple, safe, and effective fixation method.
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Affiliation(s)
- Jianxiong Zheng
- Department of Orthopaedics, Division of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Xiang
- Department of Orthopaedics and Traumatology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Jianping Zheng
- Department of Orthopaedics, HuiZhou First Hospital, Huizhou, China
| | - Xiaoreng Feng
- Department of Orthopaedics, Division of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Chen
- Department of Orthopaedics, Division of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Wang TY, Park C, Dalton T, Rajkumar S, McCray E, Owolo E, Than KD, Abd-El-Barr MM. Robotic navigation in spine surgery: Where are we now and where are we going? J Clin Neurosci 2021; 94:298-304. [PMID: 34863454 DOI: 10.1016/j.jocn.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/31/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Robotic navigation is a new and rapidly emerging niche within minimally invasive spine surgery. The robotic arms-race began in 2004 and has resulted in no less than four major robotic surgical adjuncts. Current Food and Drug Administration (FDA)-approved applications of robotic navigation are limited to pedicle screw instrumentation, but new indications and experimental applications are rapidly emerging. As with any new technology, robotic navigation must be vetted for clinical efficacy, efficiency, safety, and cost-effectiveness. Given the rapid advancements made on a yearly basis, it is important to make frequent and objective assessments of the available technology. Thus, the authors seek to provide the most up-to-date review of the history, currently available technology, learning curve, novel applications, and cost effectiveness of today's available robotic systems as it relates to spine surgery.
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Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
| | | | - Tara Dalton
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Edwin McCray
- School of Medicine, Duke University, Durham, NC, USA
| | - Edwin Owolo
- School of Medicine, Duke University, Durham, NC, USA
| | - Khoi D Than
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA
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Zheng J, Feng X, Xiang J, Liu F, Leung FKL, Chen B. S2-alar-iliac screw and S1 pedicle screw fixation for the treatment of non-osteoporotic sacral fractures: a finite element study. J Orthop Surg Res 2021; 16:651. [PMID: 34717718 PMCID: PMC8557573 DOI: 10.1186/s13018-021-02805-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Five different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics. Methods Denis type I sacral fractures were created by FE modeling. Five different fixation methods for the posterior pelvic ring were simulated: sacroiliac screw (SIS), lumbopelvic fixation (LPF), transiliac internal fixator (TIFI), S2-alar-iliac (S2AI) screw and S1 pedicle screw fixation (S2AI-S1) and S2AI screw and contralateral S1 pedicle screw fixation (S2AI-CS1). Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending and left twisting, respectively. Vertical stiffness, relative displacement and change in relative displacement were recorded and analyzed. Results As predicted by the FE model, the vertical stiffness of the five groups in descending order was S2AI-S1, SIS, S2AI-CS1, LPF and TIFI. In terms of relative displacement, groups S2AI-S1 and S2AI-CS1 displayed a lower mean relative displacement, although group S2AI-CS1 exhibited greater displacement in the upper sacrum than group S2AI-S1. Group SIS displayed a moderate mean relative displacement, although the displacement of the upper sacrum was smaller than the corresponding displacement in group S2AI-CS1, while groups LPF and TIFI displayed larger mean relative displacements. Finally, in terms of change in relative displacement, groups TIFI and LPF displayed the greatest fluctuations in their motion, while groups SIS, S2AI-S1 and S2AI-CS1 displayed smaller fluctuations. Conclusion Compared with SIS, unilateral LPF and TIFI, group S2AI-S1 displayed the greatest biomechanical stability of the Denis type I sacral fracture FE models. When the S1 pedicle screw insertion point on the affected side is damaged, S2AI-CS1 can be used as an appropriate alternative to S2AI-S1. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02805-8.
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Affiliation(s)
- Jianxiong Zheng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xiaoreng Feng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.,Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/f, Professorial Block, Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.,Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China
| | - Jie Xiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Frankie K L Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/f, Professorial Block, Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
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Suresh KV, Ikwuezunma I, Margalit A, Sponseller PD. Spinal Fusion with Sacral Alar Iliac Pelvic Fixation in Severe Neuromuscular Scoliosis. JBJS Essent Surg Tech 2021; 11:ST-D-20-00060. [PMID: 34650826 DOI: 10.2106/jbjs.st.20.00060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neuromuscular scoliosis is characterized by rapid progression of curvature during growth and may continue to progress following skeletal maturity. Posterior spinal fusion in patients with cerebral palsy and severe scoliosis results in substantial improvements in health-related quality of life1. Correction of pelvic obliquity can greatly improve sitting balance, reduce pain, and decrease skin breakdown. The sacral alar iliac (SAI) technique has key advantages over prior techniques, including the Galveston and iliac-screw techniques. The SAI technique eliminates the need for subcutaneous muscle dissection over the iliac crest, does not require the use of connectors from the rod to the iliac screw, and decreases the risk of implant prominence2. Description We demonstrate how to perform posterior spinal fusion with SAI pelvic fixation in a patient with cerebral palsy. In correcting the scoliosis, we utilize the segmental 3-dimensional technique, which includes compression, distraction, transverse approximation to 1 rod at a time, and derotation around 2 rods. We also demonstrate SAI pelvic fixation with identification of the screw starting point on the lateral-caudal border of the first sacral foramen and trajectory toward the anterior inferior iliac spine. Alternatives Nonoperative alternatives include bracing, trunk support, contouring of sitting surfaces (such as wheelchairs), and physical therapy to slow curve progression during growth periods and delay the need for surgical treatment3,4. Decision-making is shared with the family following education about the risks and benefits. Families who are satisfied with the function of the child at baseline should not be persuaded into pursuing surgical treatment. Rationale Neuromuscular scoliosis can include difficulty sitting secondary to increased pelvic obliquity, along with poor trunk control and balance. Surgical intervention is considered in patients with curves exceeding approximately 50°, as these curves will often continue to progress even after maturity5. In patients with neuromuscular scoliosis, indications for pelvic fixation include pelvic obliquity of >15°, poor control of the trunk as indicated by lack of independent sitting or standing, and location of the apex of the curve in the lumbar spine. SAI screws are utilized as a low-profile option for pelvic fixation to avoid implant prominence and an increased risk of skin breakdown and infection, which are associated with traditional sacroiliac screws2,6. Expected Outcomes Miyanji et al. reported quality outcomes in patients with cerebral palsy and Gross Motor Function Classification Scores of ≥41. In that study, caregivers completed a validated disease-specific questionnaire grading the health-related quality of life of the patient preoperatively and at 1, 2, and 5 years postoperatively. Complication data were prospectively collected for each patient and preoperative outcome scores were compared at each of the postoperative time points. Survey scores at 1, 2, and 5 years postoperatively were significantly higher compared with baseline preoperative values.Sponseller et al. compared the 2-year postoperative radiographic parameters of 32 pediatric patients who underwent SAI fixation and 27 patients who underwent pelvic fixation with the sacroiliac technique2. Among patients who underwent SAI fixation, the mean correction of pelvic obliquity was 20° ± 11° (70% correction) and the mean Cobb angle 42° ± 25° (67%). Among patients who underwent pelvic fixation with the sacroiliac technique, those values were 10° ± 9° (50%) and 46° ± 16° (60%), respectively. SAI screws provided significantly better pelvic obliquity correction (p = 0.002) but no difference in Cobb correction or complications compared with other traditional techniques. Important Tips Family discussion prior to surgical treatment is paramount.Perform preoperative neurologic examination7.Examine the cranium carefully for a ventriculoperitoneal shunt or prior cranial reconstruction prior to cranial traction.Transcranial neuromonitoring may be useful. Use descending neural motor evoked potentials when no signals from transcranial monitoring are obtained8.Sink the SAI screw until it lines up with the S1 screw. Bury the SAI screw so it is not prominent.Measure rods longer in order to ensure adequate length for compression and distraction in correction of the pelvic obliquity.Use a T-square to verify adequate spinopelvic alignment9.Postoperatively, the use of incisional vacuum-assisted closure can decrease soiling in these patients. Acronyms and Abbreviations SAI = Sacral alar iliacCP = Cerebral palsyAIS = Adolescent idiopathic scoliosisSMA = Spinal muscular atrophyIONM = Intraoperative neuromonitoringGMFCS = Gross Motor Functional Classification SystemDNMEP = Descending neural motor evoked potentialTXA = Tranexamic acidFFP = Fresh frozen plasmaASIS = Anterior superior iliac spineAIIS = Anterior inferior iliac spinePJK = Proximal junctional kyphosis.
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Affiliation(s)
- Krishna V Suresh
- Department of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, Maryland
| | - Ijezie Ikwuezunma
- Department of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, Maryland
| | - Adam Margalit
- Department of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, Maryland
| | - Paul D Sponseller
- Department of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, Maryland
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Uotani K, Tanaka M, Sonawane S, Ruparel S, Fujiwara Y, Arataki S, Yamauchi T, Misawa H. Comparative Study of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screw for Adult Spine Deformities. World Neurosurg 2021; 156:e300-e306. [PMID: 34560299 DOI: 10.1016/j.wneu.2021.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the feasibility of O-arm navigation of bilateral dual sacral-alar-iliac (SAI) screws compared with conventional bilateral single SAI and S1 pedicle screws for pelvic anchors in cases of adult spinal deformity. METHODS This retrospective, comparative study included 39 patients who underwent corrective fusion using SAI screws from T10 to the pelvis. Patients were divided into 2 groups according to the number of SAI screws placed during adult spinal deformity surgery: single SAI screw (group S, 17 cases) and dual SAI screws (group D, 22 cases). The incidence of rod breakage, proximal junctional kyphosis, screw loosening, reoperation, and global alignment in each group was estimated. Postoperative patient-reported outcomes were measured using the Oswestry Disability Index, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, and visual analog scale. RESULTS The incidence of SAI screw loosening was significantly lower in group D than in group S (23% vs. 65%, P = 0.011). The rod breakage incidence was 0% and 12% in groups D and S, respectively (P = 0.17). There were no significant differences in the postoperative global alignment and clinical outcomes between the 2 groups. CONCLUSIONS Dual SAI screws were associated with a significantly reduced incidence of screw loosening compared with single SAI screws. The bilateral dual SAI screws technique for pelvic anchors is feasible for the treatment of patients with adult spinal deformity.
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Affiliation(s)
- Koji Uotani
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan; Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan.
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Sumeet Sonawane
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Sameer Ruparel
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Shinya Arataki
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Taro Yamauchi
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Haruo Misawa
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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de Andrada Pereira B, Wangsawatwong P, Lehrman JN, Sawa AGU, Lindsey DP, Yerby SA, Godzik J, Waguespack AM, Uribe JS, Kelly BP. Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution. J Neurosurg Spine 2021; 36:42-52. [PMID: 34534964 DOI: 10.3171/2021.3.spine202175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE S2 alar-iliac (S2AI) screw fixation effectively enhances stability in long-segment constructs. Although S2AI fixation provides a single transarticular sacroiliac joint fixation (SIJF) point, additional fixation points may provide greater stability and attenuate screw and rod strain. The objectives of this study were to evaluate changes in stability and pedicle screw and rod strain with extended distal S2AI fixation and with supplemental bilateral integration of two sacroiliac joint fusion devices implanted using a traditional minimally invasive surgical approach. METHODS Eight L1-pelvis human cadaveric specimens underwent pure moment (7.5 Nm) and compression (400 N) tests under 4 conditions: 1) intact (pure moment loading only); 2) L2-S1 pedicle screw and rod with L5-S1 interbody fusion; 3) added S2AI screws; and 4) added bilateral laterally placed SIJF. Range of motion (ROM), rod strain, and screw-bending moment (S1 and S2AI) were analyzed. RESULTS Compared with S1 fixation, S2AI fixation significantly reduced L5-S1 ROM in right lateral bending by 50% (0.11°, p = 0.049) and in compression by 39% (0.22°, p = 0.003). Compared with fixation ending at S1, extending fixation with S2AI significantly decreased sacroiliac joint ROM by 52% (0.28°, p = 0.02) in flexion, by 65% (0.48°, p = 0.04) in extension, by 59% (0.76°, p = 0.02) in combined flexion-extension, and by 36% (0.09°, p = 0.02) in left axial rotation. The addition of S2AI screws reduced S1 screw-bending moment during flexion (0.106 Nm [43%], p = 0.046). With S2AI fixation, posterior L5-S1 primary rod strain increased by 124% (159 μE, p = 0.002) in flexion, by 149% (285 μE, p = 0.02) in left axial rotation, and by 99% (254 μE, p = 0.04) in right axial rotation. Compared with S2AI fixation, the addition of SIJF reduced L5-S1 strain during right axial rotation by 6% (28 μE, p = 0.04) and increased L5-S1 strain in extension by 6% (28 μE, p = 0.02). CONCLUSIONS Long-segment constructs ending with S2AI screws created a more stable construct than those ending with S1 screws, reducing lumbosacral and sacroiliac joint motion and S1 screw-bending moment in flexion. These benefits, however, were paired with increased rod strain at the lumbosacral junction. The addition of SIJF to constructs ending at S2AI did not significantly change SI joint ROM or S1 screw bending and reduced S2AI screw bending in compression. SIJF further decreased L5-S1 rod strain in axial rotation and increased it in extension.
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Affiliation(s)
- Bernardo de Andrada Pereira
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Piyanat Wangsawatwong
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jennifer N Lehrman
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Anna G U Sawa
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | - Jakub Godzik
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | - Juan S Uribe
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Brian P Kelly
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Martin CT, Holton KJ, Jones KE, Sembrano JN, Polly DW. Bilateral open sacroiliac joint fusion during adult spinal deformity surgery using triangular titanium implants: technique description and presentation of 21 cases. J Neurosurg Spine 2021; 36:86-92. [PMID: 34507297 DOI: 10.3171/2021.3.spine202218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pelvic fixation enhances long constructs during deformity surgery. Subsequent loosening of iliac screws and pain at the pelvis occur in as many as 29% of patients. Concomitant sacroiliac (SI) fusion may prevent potential pain and failure. The objective of this study was to describe a novel surgical technique and a single institution's experience using bilateral SI fusion during adult deformity surgery with S2-alar-iliac (S2AI) screws and triangular titanium rods (TTRs) placed with navigation. METHODS The authors reviewed open SI joint fusions with TTR performed between August 2019 and March 2020. All patients underwent lumbosacral fusion through a midline approach and bilateral S2AI pelvic fixation in the caudal teardrop, followed by TTR placement just proximal and cephalad to the S2AI screws using intraoperative CT imaging guidance. RESULTS Twenty-one patients were identified who received 42 TTRs, ranging in size from 7.0 × 65 mm to 7.0 × 90 mm. Three TTRs (7%) were malpositioned intraoperatively, and each was successfully repositioned during index surgery without negative sequelae. All breaches occurred in a medial and cephalad direction into the pelvis. Incremental operative time for adding TTR averaged 8 minutes and 33 seconds per implant. CONCLUSIONS Image-guided open SI joint fusion with TTR during lumbosacral fusion is technically feasible. The bony corridor for implant placement is narrower cephalad, and implants tend to deviate medially into the pelvis. Detection of malpositioned implant is aided with intraoperative CT, but this can be salvaged. A prospective randomized clinical trial is underway that will better inform the impact of this technique on patient outcomes.
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Affiliation(s)
| | | | - Kristen E Jones
- Departments of1Orthopedic Surgery and.,2Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | | | - David W Polly
- Departments of1Orthopedic Surgery and.,2Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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Martin CT, Polly DW, Holton KJ, San Miguel-Ruiz JE, Albersheim M, Lender P, Sembrano JN, Hunt MA, Jones KE. Acute failure of S2-alar-iliac screw pelvic fixation in adult spinal deformity: novel failure mechanism, case series, and review of the literature. J Neurosurg Spine 2021; 36:53-61. [PMID: 34479206 DOI: 10.3171/2021.2.spine201921] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pelvic fixation with S2-alar-iliac (S2AI) screws is an established technique in adult deformity surgery. The authors' objective was to report the incidence and risk factors for an underreported acute failure mechanism of S2AI screws. METHODS The authors retrospectively reviewed a consecutive series of ambulatory adults with fusions extending 3 or more levels, and which included S2AI screws. Acute failure of S2AI screws was defined as occurring within 6 months of the index surgery and requiring surgical revision. RESULTS Failure occurred in 6 of 125 patients (5%) and consisted of either slippage of the rods or displacement of the set screws from the S2AI tulip head, with resultant kyphotic fracture. All failures occurred within 6 weeks postoperatively. Revision with a minimum of 4 rods connecting to 4 pelvic fixation points was successful. Two of 3 (66%) patients whose revision had less fixation sustained a second failure. Patients who experienced failure were younger (56.5 years vs 65 years, p = 0.03). The magnitude of surgical correction was higher in the failure cohort (number of levels fused, change in lumbar lordosis, change in T1-pelvic angle, and change in coronal C7 vertical axis, each p < 0.05). In the multivariate analysis, younger patient age and change in lumbar lordosis were independently associated with increased failure risk (p < 0.05 for each). There was a trend toward the presence of a transitional S1-2 disc being a risk factor (OR 8.8, 95% CI 0.93-82.6). Failure incidence was the same across implant manufacturers (p = 0.3). CONCLUSIONS All failures involved large-magnitude correction and resulted from stresses that exceeded the failure loads of the set plugs in the S2AI tulip, with resultant rod displacement and kyphotic fractures. Patients with large corrections may benefit from 4 total S2AI screws at the time of the index surgery, particularly if a transitional segment is present. Salvage with a minimum of 4 rods and 4 pelvic fixation points can be successful.
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Affiliation(s)
| | - David W Polly
- 1Department of Orthopaedic Surgery, University of Minnesota; and.,2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Kenneth J Holton
- 1Department of Orthopaedic Surgery, University of Minnesota; and
| | | | | | - Paul Lender
- 1Department of Orthopaedic Surgery, University of Minnesota; and
| | | | - Matthew A Hunt
- 2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Kristen E Jones
- 1Department of Orthopaedic Surgery, University of Minnesota; and.,2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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Zhao Y, Yuan B, Han Y, Zhang B. Radiographic analysis of the sacral-2-alar screw trajectory. J Orthop Surg Res 2021; 16:522. [PMID: 34425863 PMCID: PMC8381482 DOI: 10.1186/s13018-021-02626-9] [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: 06/04/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To explore the feasibility of sacral-2-alar (S2-alar) screw placement by measuring the length, diameter, and angle of the screw trajectory on computed tomography (CT). Methods This study selected 100 Han-nationality adults in northern China with a normal spine and pelvis. CT data were imported into PHILIPS software for reconstructing the 3D digital images. The optimal S2-alar screw trajectory was imitated on CT. Parameters including the length of the screw trajectory, sagittal angle, coronal angle, distance between the entry point and the spinous process, and minimum diameter of the screw trajectory were measured to evaluate the application of S2-alar screws. Results In total, 48 males and 52 females were included. The average length of the left screw trajectory was 47.18 ± 3.91 mm. The sagittal angle was 29.06 ± 4.00°. The coronal angle was 13.31 ± 6.95°. The distance between the entry point and the spinous process was 21.0 (3.7) mm. The minimum diameter of the screw trajectory was 17.1 (2.3) mm. The average length of the right screw trajectory was 45.46 ± 4.37 mm. The sagittal angle was 23.33 ± 4.26°. The coronal angle was 14.88 ± 6.84°. The distance between the entry point and the spinous process was 22.8 (2.9) mm. The minimum diameter of the screw trajectory was 16.9 (3.1) mm. In women, the average length of the left screw trajectory was 44.80 ± 3.66 mm. The sagittal angle was 32.14 ± 5.48°. The coronal angle was 16.04 ± 7.74°. The distance between the entry point and the spinous process was 21.8 (2.8) mm. The minimum diameter of the screw trajectory was 17.1 (5) mm. The average length of the right screw trajectory was 44.01 ± 3.72 mm. The sagittal angle was 25.12 ± 5.19. The coronal angle was 16.67 ± 8.34°. The distance between the entry point and the spinous process was 21.6 (2.7) mm. The minimum diameter of the screw trajectory was 17 (4.5) mm. As seen from the data, there were significant differences in the minimum diameter of the screw trajectory in both males and females. In females, there were also significant differences between the left and right sides in the coronal angle. Between males and females, there were statistically significant differences in the length of the screw trajectory. There were no statistically significant differences in the other parameters between males and females. Conclusion The optimal screw trajectory of the S2-alar screw can be found on CT. The length and deflection angle of the screw meet the clinical requirements. This method is easy to perform and feasible for clinical application.
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Affiliation(s)
- Yulin Zhao
- Department of Orthopedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, No. 758 Hefei Road, Shandong, 266035, Qingdao, China
| | - Baisheng Yuan
- Department of Orthopedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, No. 758 Hefei Road, Shandong, 266035, Qingdao, China.
| | - Yijun Han
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
| | - Binglei Zhang
- Department of Orthopedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, No. 758 Hefei Road, Shandong, 266035, Qingdao, China
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Luo Q, Kim YC, Kim KT, Ha KY, Ahn J, Kim SM, Kim MG. Use of iliac screw associated with more correction of lumbar lordosis than S2-alar-iliac screw for adult spinal deformity. BMC Musculoskelet Disord 2021; 22:676. [PMID: 34376177 PMCID: PMC8356396 DOI: 10.1186/s12891-021-04568-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2023] Open
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 who 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 Compared with the S2AI technique, the IS technique usable larger cantilever force demonstrated more correction of lumbar lordosis, and possible increase in pelvic incidence. Further study is warranted to clarify the clinical impaction of these results.
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Affiliation(s)
- Qiang Luo
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - Yong-Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea.
| | - Ki-Tack Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea
| | - Joonghyun Ahn
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea
| | - Sung-Min Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea
| | - Min-Gyu Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, South Korea
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Von Glinski A, Pierre C, Frieler S, Mahoney JM, Harris JA, Amin DB, Allall M, Bucklen BS, Schildhauer TA, Oskouian RJ, Chapman JR. Fixation Strength of Modified Iliac Screw Trajectory Compared to Traditional Iliac and S2 Alar-Iliac Trajectories: A Cadaveric Study. World Neurosurg 2021; 154:e481-e487. [PMID: 34298135 DOI: 10.1016/j.wneu.2021.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Traditional iliac (TI) screws require extensive dissection, involve offset-connectors, and have prominent screw heads that may cause patient discomfort. S2 alar-iliac (S2AI) screws require less dissection, do not need offset connectors, and are less prominent. However, the biomechanical consequences of S2AI screws crossing the alar-iliac joint is unknown. The present study investigates the fixation strength of a modified iliac (MI) screw, which has a more medial entry point and reduced screw prominence, but does not cross the alar-iliac joint. METHODS Eighteen sacropelvic spines were divided into 3 groups (n = 6): TI, S2AI, and MI. Each specimen was fixed unilaterally with S1 pedicle screws and pelvic fixation according to its group. Screws were loaded at ±10 Nm at 3Hz for 1000 cycles. Motion of each screw and rod strain above and below the S1 screw was measured. RESULTS Toggle of the S1 screw was lowest for the TI group, followed by the MI and S2AI groups, but there were no significant differences (P = 0.421). Toggle of the iliac screw relative to the pelvis was also lowest for the TI group, followed by the MI group, and was greatest for the S2AI group, without significant differences (P = 0.179). Rod strain was similar across all groups. CONCLUSIONS No statistically significant differences were found between the TI, S2AI, and MI techniques with regard to screw toggle or rod strain. Advantages of the MI screw include its lower profile and a medialized starting point eliminating the need for offset-connectors.
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Affiliation(s)
- Alexander Von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; University Hospital Bergmannsheil, Bochum, Germany.
| | - Clifford Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Sven Frieler
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, Pennsylvania, USA
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, Pennsylvania, USA
| | - Dhara B Amin
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, Pennsylvania, USA
| | - May Allall
- College of Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, Pennsylvania, USA
| | | | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
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Douleh DG, Greig D, Thompson R, Garg S. When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis? J Pediatr Orthop 2021; 41:S53-S58. [PMID: 34096538 PMCID: PMC10364839 DOI: 10.1097/bpo.0000000000001821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The goal of neuromuscular scoliosis (NMS) surgery is to improve sitting balance, facilitate daily care, and alleviate pain. In nonambulatory patients, where sitting balance is key, fusion to the pelvis is usually required. However, in minimally ambulatory patients, fusion to the pelvis remains controversial, and there is considerable practice variability in this patient population. The purpose of this study is to evaluate and summarize the available evidence regarding fusion constructs in minimally ambulatory patients with NMS and to provide expert opinion regarding when fusion to the pelvis should be considered. METHODS A search of the English literature was performed using PubMed to identify papers pertaining to patients with NMS treated with instrumented posterior spinal fusion. Papers published before 2000, case reports, and level V evidence were excluded. RESULTS The authors identified 8 studies for review. The majority included both nonambulatory and minimally ambulatory patients. Structured review of the literature demonstrated fusion to the pelvis may allow for greater curve and pelvic obliquity correction, but it is also associated with increased blood loss and operative time. There is no evidence that fusing to the pelvis decreases ambulatory status in minimally ambulatory patients. CONCLUSIONS In minimally ambulatory patients with NMS, fusion short of the pelvis may be considered in patients with adequate head control without the presence of hip subluxation or dislocation and when pelvic obliquity is <15 degrees. Fusion to the pelvis is recommended in patients who do not meet these criteria.
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Affiliation(s)
- Diana G. Douleh
- Department of Orthopedics, Anschutz Medical Campus, Aurora, CO
| | - Danielle Greig
- Department of Orthopedics, University of California Los Angeles, Los Angeles, CA
| | - Rachel Thompson
- Department of Orthopedics, University of California Los Angeles, Los Angeles, CA
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Wu Z, Schwend RM, Anderson JT, Marasigan JAM, Price NJ. Iliac screw instrumentation to the pelvis in children with neuromuscular and syndromic scoliosis. No lateral connectors and respect sagittal balance. Spine Deform 2021; 9:1115-1123. [PMID: 33492654 DOI: 10.1007/s43390-021-00287-6] [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: 05/08/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN One-center retrospective cohort study. BACKGROUND Compared to the traditional iliac screw technique, the modified iliac screw technique has a lower rate of distal implant failure in the treatment of neuromuscular scoliosis patients with pelvic obliquity. However, the reasons for decreased failure with the modified iliac screw technique are controversial. QUESTIONS/PURPOSES (1) Is distal implant failure, as evident by implant breakage or disconnection, more likely to occur in patients receiving the traditional iliac screw technique (PSIS) compared to the modified S2AI (MODS2) technique? (2) After controlling for relevant confounding variables, are there other identifiable risk factors for distal implant failure? METHODS We identified patients who underwent pelvic screw fixation by three pediatric spine surgeons from January 2007 to July 2017. Based on the starting point of the iliac screws, patients were divided into two groups. Group 1 consisted of PSIS fixation with an offset connector. Group 2 consisted of modified S2AI fixation without an offset connector. Demographic, operative, and radiographic data were obtained. RESULTS Cobb angle, lumbar lordosis, and pelvic obliquity were not significantly different between the two groups. Overall distal implant failure was 40/100 (40%) and significant between Group 1 PSIS 29/53 (55%) and Group 2 MODS2 11/47 (23%) (p = 0.002). No other complications were significant. Three risk factors were identified with implant failure: high pelvic incidence (17-fold increase, 95% confidence interval [CI] = 5.5 to 53.1, p < 0.001), high angle rod contour (3.8-fold increase, 95% CI = 1.2 to 11.9, p = 0.023), and use of an offset connector (3.2-fold increase, 95% CI = 1.0 to 10.3, p = 0.049). Failure did not correlate with the use of a cross-link, iliac screw diameter, or screw density. Revision surgery related to distal implant failure did not significantly differ between the two groups. CONCLUSIONS Compared to the use of an offset connector with PSIS fixation, MODS2 fixation had a lower rate of implant failure. Sagittal balance parameters, namely pelvic incidence and angle of rod bend, were the major risk factors for implant failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zhenkai Wu
- Department of Orthopaedic Surgery, School of Medicine, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.,Department of Pediatric Orthopaedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Richard M Schwend
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - John T Anderson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joanne Abby M Marasigan
- Orthopaedic Surgery Department and Musculoskeletal Medicine, University of Missouri-Kansas City School of Medicine, 2301 Holmes Road, Kansas City, MO, 64108, USA
| | - Nigel J Price
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
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Sorour I, Elbary MA, Rabie A, Elhabashy AM. An early experience of lumbopelvic fixation techniques at Alexandria University. EGYPTIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1186/s41984-021-00099-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of lumbopelvic fixation is to obtain a solid fusion across the lumbosacral junction. There are many indications for lumbopelvic fixation, namely, spinal deformity in cases requiring long segment fusion, pelvic obliquity, pseudarthrosis at the lumbosacral junction, infection or osteolytic tumors, and pathologic fractures. The classical iliac screws should be contained within the iliac bone but have some disadvantages: excessive soft tissue dissection needed for accurate insertion, screw prominence with patient discomfort, and usually, a side connector is needed to connect the iliac screws to the rest of the construct. Lumbopelvic fixation by insertion of S2 alar-iliac (S2AI) screws was recently described to overcome these disadvantages. In this study, the authors present the initial results for the evaluation of lumbopelvic fixation through the insertion of S2AI screws in 19 consecutive patients operated in the neurosurgery department at Alexandria University.
Objective
The aim of the study was to evaluate the efficacy and complications of lumbopelvic fixation through the use of S2 alar-iliac screws.
Methods
The authors conducted a retrospective cohort study of data collected from the database of patients who underwent lumbopelvic fixation through the insertion of S2AI screws from 2016 to 2019 at a single institution.
Results
There were 19 patients indicated for lumbopelvic fixation, operated by modern instrumentation systems using lumbar pedicle screws and S2 alar-iliac screws. There were 14 females and 5 males. The mean age at the time of the operation was 38.6 ± 19.4 years with a range from 11 to 65 years. There was a total of 37 S2AI screws, screw diameter was 7mm in all cases regardless of age, and the length of the screws ranged from 50 mm in a young female patient (11 years) to 90 mm in an old male patient (60 years). Two screws were inserted per patient except in one case with congenital scoliosis due to the bad bone quality and the multiple iatrogenic wrong paths. Postoperative VAS score for back pain was greatly improved in all patients after the first 6 months of follow-up from 8 ± 1.5 to 3.5 ± 1.2 (paired t-test = 11.182, P<0.001). All patients had a good spinal range of motion to maintain normal daily activities without any significant restrictions after the first 3 months of follow-up. Immediate postoperative radiological follow-up had revealed 2 cases of posterior pelvic breaches and one case with anterior pelvic breach but without clinical manifestations with no need for revision. Two cases of unilateral screw breakout were observed after the first 6 months of follow-up. Removal of screws after the first 6 months was done in one patient with spondylodiscitis due to the unresolved infection and screw pullout.
Conclusion
The insertion of S2AI screws is an effective technique for lumbopelvic fixation with a relatively low rate of complications. Pelvic breaches are the commonest complications encountered during the insertion of S2AI screws, although no significant clinical morbidities were reported.
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de Andrada Pereira B, Lehrman JN, Sawa AGU, Lindsey DP, Yerby SA, Godzik J, Waguespack AM, Uribe JS, Kelly BP. Biomechanical effects of a novel posteriorly placed sacroiliac joint fusion device integrated with traditional lumbopelvic long-construct instrumentation. J Neurosurg Spine 2021:1-10. [PMID: 34144523 DOI: 10.3171/2020.11.spine201540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE S2-alar-iliac (S2AI) screw fixation effectively ensures stability and enhances fusion in long-segment constructs. Nevertheless, pelvic fixation is associated with a high rate of mechanical failure. Because of the transarticular nature of the S2AI screw, adding a second point of fixation may provide additional stability and attenuate strains. The objective of the study was to evaluate changes in stability and strain with the integration of a sacroiliac (SI) joint fusion device, implanted through a novel posterior SI approach, supplemental to posterior long-segment fusion. METHODS L1-pelvis human cadaveric specimens underwent pure moment (7.5 Nm) and compression (400 N) tests in the following conditions: 1) intact, 2) L2-S1 pedicle screw and rod fixation with L5-S1 interbody fusion, 3) added S2AI screws, and 4) added bilateral SI joint fixation (SIJF). The range of motion (ROM), rod strain, and screw bending moments (S1 and S2AI) were analyzed. RESULTS S2AI fixation decreased L2-S1 ROM in flexion-extension (p ≤ 0.04), L5-S1 ROM in flexion-extension and compression (p ≤ 0.004), and SI joint ROM during flexion-extension and lateral bending (p ≤ 0.03) compared with S1 fixation. SI joint ROM was significantly less with SIJF in place than with the intact joint, S1, and S2AI fixation in flexion-extension and lateral bending (p ≤ 0.01). The S1 screw bending moment decreased following S2AI fixation by as much as 78% in extension, but with statistical significance only in right axial rotation (p = 0.03). Extending fixation to S2AI significantly increased the rod strain at L5-S1 during flexion, axial rotation, and compression (p ≤ 0.048). SIJF was associated with a slight increase in rod strain versus S2AI fixation alone at L5-S1 during left lateral bending (p = 0.048). Compared with the S1 condition, fixation to S2AI increased the mean rod strain at L5-S1 during compression (p = 0.048). The rod strain at L5-S1 was not statistically different with SIJF compared with S2AI fixation (p ≥ 0.12). CONCLUSIONS Constructs ending with an S2AI screw versus an S1 screw tended to be more stable, with reduced SI joint motion. S2AI fixation decreased the S1 screw bending moments compared with fixation ending at S1. These benefits were paired with increased rod strain at L5-S1. Supplementation of S2AI fixation with SIJF implants provided further reductions (approximately 30%) in the sagittal plane and lateral bending SI joint motion compared with fixation ending at the S2AI position. This stability was not paired with significant changes in rod or screw strains.
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Affiliation(s)
| | | | - Anna G U Sawa
- 1Department of Neurosurgery, Spinal Biomechanics Laboratory, and
| | | | | | - Jakub Godzik
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Juan S Uribe
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brian P Kelly
- 1Department of Neurosurgery, Spinal Biomechanics Laboratory, and
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Margalit A, Suresh KV, Hayashi B, Sponseller PD. Surgical Treatment of Unstable Pelvic Ring Injury in a Young Child: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00108. [PMID: 34111040 DOI: 10.2106/jbjs.cc.20.00942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe an anterior and posterior pelvic ring construct, with emphasis on the posterior construct, to treat a vertical displacement fracture in a 2-year-old girl who was struck by a motor vehicle. Eighteen months after her injury, radiographs showed intact sacroiliac joints and symmetrical pubic symphysis. CONCLUSION Although commonly performed in adults, pelvic fixation is challenging in children because of the small size of the child's pelvis and osseous fixation pathways. However, this approach enabled successful vertical stabilization of the pelvis, complete resolution of symphyseal diastasis, and recovery of function and mobility.
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Affiliation(s)
- Adam Margalit
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint. INTERNATIONAL ORTHOPAEDICS 2021; 45:1793-1802. [PMID: 34086124 DOI: 10.1007/s00264-021-05096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reconstruction of the pelvic ring after the resection of pelvic tumours involving the sacroiliac joint is challenging. Although pedicle screw and rod system reconstructions are commonly performed, failure at the early stage has been reported. Surgical procedures Reconstruction involving two or more strong anchor screws (iliac, ischial, and pubis screws) into the residual pelvis, connecting with at least two rods with minimal bending to the residual lumbosacral vertebra and contralateral pelvis. METHODS The above reconstruction was performed for six malignant bone and soft-tissue pelvic tumours requiring Enneking type I + IV resection. A double-barreled free non-vascularized fibular graft was used in all patients, except for one. Patients were followed up for a mean period of 51 months (range, 9 to 96 months), and peri-operative complications, implant failure within the follow-up period, and the clinical results of surgery were investigated. RESULTS The mean age of four females and two males at the initial surgery was 37.2 years. One patient developed a deep wound infection. Two patients died due to metastasis of the tumor. All patients were able to walk on their own within 12 weeks of surgery. There was no implant failure, except in two patients with contralateral lumbosacral rod fracture three and four years after surgery, for which one patient required rod replacement. CONCLUSIONS The incidence of implant failure, particularly around the resection site, was low, which may be attributed to multiple periacetabular screws and rods with minimal bending. Our rigid reconstruction method enables the rapid resumption of walking.
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