1
|
Hwang CJ, Lee JY, Lee DH, Cho JH, Lee CS, Lee MY, Yoon SJ. Novel Screw Placement Method for Extremely Small Lumbar Pedicles in Scoliosis. J Clin Med 2024; 13:1115. [PMID: 38398428 PMCID: PMC10888630 DOI: 10.3390/jcm13041115] [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: 12/22/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Study Design: Consecutive case series. Objective: To propose a screw placement method in patients with extremely small lumbar pedicles (ESLPs) (<2 mm) to maintain screw density and correction power, without relying on the O-arm navigation system. Summary of Background Data: In scoliosis surgery, ESLPs can hinder probe passage, resulting in exclusion or substitution of the pedicle screws with a hook. Screw density affects correction power, making it necessary to maximize the number of screw placements, especially in the lumbar curve. Limited studies provide technical guidelines for screw placement in patients with ESLPs, independent of the O-arm navigation system. Methods: We enrolled 19 patients who underwent scoliosis correction surgery using our novel screw placement method for ESLPs. Clinical, radiological, and surgical parameters were assessed. After posterior exposure of the spine, the C-arm fluoroscope was rotated to obtain a true posterior-anterior view and both pedicles were symmetrically visualized. An imaginary pedicle outline was presumed based on the elliptical or linear shadow from the pedicle. The screw entry point was established at a 2 (or 10) o'clock position in the presumed pedicle outline. After adjusting the gear-shift convergence, both cortices of the transverse process were penetrated and the tip was advanced towards the lateral vertebral body wall, where an extrapedicular screw was placed with tricortical fixation. Results: Out of 90 lumbar screws in 19 patients, 33 screws were inserted using our novel method, without correction loss or complications during an average follow-up period of 28.44 months, except radiological loosening of one screw. Conclusions: Our new extrapedicular screw placement method into the vertebral body provides an easy, accurate, and safe alternative for scoliosis patients with ESLPs without relying on the O-arm navigation system. Surgeons must consider utilizing this method to enhance correction power in scoliosis surgery, regardless of the small size of the lumbar pedicle.
Collapse
Affiliation(s)
- Chang-Ju Hwang
- Department of Orthopedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (J.-H.C.)
| | - Joo-Young Lee
- Department of Orthopedic Surgery, Dong-A Medical Center, University of Dong-A College of Medicine, Busan 49201, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (J.-H.C.)
| | - Jae-Hwan Cho
- Department of Orthopedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (J.-H.C.)
| | - Choon-Sung Lee
- Department of Orthopedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (J.-H.C.)
| | - Mi-Young Lee
- Department of Orthopedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (J.-H.C.)
| | - So-Jung Yoon
- Department of Orthopedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea (J.-H.C.)
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Ishii K, Watanabe G, Tomita T, Nikaido T, Hikata T, Shinohara A, Nakano M, Saito T, Nakanishi K, Morimoto T, Isogai N, Funao H, Tanaka M, Kotani Y, Arizono T, Hoshino M, Sato K. Minimally Invasive Spinal Treatment (MIST)—A New Concept in the Treatment of Spinal Diseases: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58081123. [PMID: 36013590 PMCID: PMC9413482 DOI: 10.3390/medicina58081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
In the past two decades, minimally invasive spine surgery (MISS) techniques have been developed for spinal surgery. Historically, minimizing invasiveness in decompression surgery was initially reported as a MISS technique. In recent years, MISS techniques have also been applied for spinal stabilization techniques, which were defined as minimally invasive spine stabilization (MISt), including percutaneous pedicle screws (PPS) fixation, lateral lumbar interbody fusion, balloon kyphoplasty, percutaneous vertebroplasty, cortical bone trajectory, and cervical total disc replacement. These MISS techniques typically provide many advantages such as preservation of paraspinal musculature, less blood loss, a shorter operative time, less postoperative pain, and a lower infection rate as well as being more cost-effective compared to traditional open techniques. However, even MISS techniques are associated with several limitations including technical difficulty, training opportunities, surgical cost, equipment cost, and radiation exposure. These downsides of surgical treatments make conservative treatments more feasible option. In the future, medicine must become “minimally invasive” in the broadest sense—for all patients, conventional surgeries, medical personnel, hospital management, nursing care, and the medical economy. As a new framework for the treatment of spinal diseases, the concept of minimally invasive spinal treatment (MIST) has been proposed.
Collapse
Affiliation(s)
- Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba 286-8686, Japan
- Spine and Spinal Cord Center, Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo 108-8329, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Chiba 286-8520, Japan
| | | | - Takashi Tomita
- Department of Orthopaedic Surgery, Aomori Prefectural Central Hospital, Aomori 030-8553, Japan
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan
| | - Akira Shinohara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo 105-8471, Japan
| | - Masato Nakano
- Department of Orthopaedic Surgery, Takaoka City Hospital, Takaoka 933-8550, Japan
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka 573-1191, Japan
| | - Kazuo Nakanishi
- Department of Orthopaedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Saga University School of Medicine, Saga 849-8501, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba 286-8686, Japan
- Spine and Spinal Cord Center, Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo 108-8329, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba 286-8686, Japan
- Spine and Spinal Cord Center, Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo 108-8329, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Chiba 286-8520, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Yoshihisa Kotani
- Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Osaka 573-1010, Japan
| | - Takeshi Arizono
- Department of Orthopaedic Surgery, Kyushu Central Hospital, Fukuoka 815-0032, Japan
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo 121-0807, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya 466-8650, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Funao H, Yamanouchi K, Fujita N, Kado Y, Kato S, Otomo N, Isogai N, Sasao Y, Ebata S, Kitagawa Y, Watanabe K, Obara H, Ishii K. Comparative Study of S2-Alar-Iliac Screw Trajectories between Males and Females Using Three-Dimensional Computed Tomography Analysis: The True Lateral Angulation of the S2-Alar-Iliac Screw in the Axial Plane. J Clin Med 2022; 11:jcm11092511. [PMID: 35566635 PMCID: PMC9104294 DOI: 10.3390/jcm11092511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
The S2 alar-iliac screw (S2AIS) is commonly used for long spinal fusion as a rigid distal foundation in spinal deformity surgeries, and it is also used in percutaneous sacropelvic fixation for providing an in-line connection to the proximal spinal constructs without using offset connectors. Although the pelvic shape is different between males and females, reports on S2AIS trajectories according to gender have been scarce in the literature. In this paper, S2AIS trajectories are compared between males and females using pelvic three-dimensional computed tomography (3D-CT) in a normal Japanese population. After resetting the caudal angulation in CT-imaging plane manipulation, the angulation of S2AIS was more lateral in the axial plane and more horizontal in the coronal plane in females. Mean distances from the midline to starting points of S2AIS tended to be shorter in females, whereas mean distances from the midline to the posterior superior iliac spine was significantly longer in females. We also found that there were positive correlations between the patients’ height and the maximal lengths of S2AISs, and the patients’ height and minimal areas of S2AIS pathways. Our results are useful not only for conventional open spinal surgery, but also for minimally invasive spine surgery.
Collapse
Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan;
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Correspondence: (H.F.); (K.I.); Tel.: +81-476-35-5600 (H.F. & K.I.)
| | - Kento Yamanouchi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan;
| | - Naruhito Fujita
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan;
| | - Yukihiro Kado
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan;
| | - Shuzo Kato
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Nao Otomo
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan;
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (Y.K.); (H.O.)
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (Y.K.); (H.O.)
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-0048, Japan; (K.Y.); (N.F.); (S.K.); (N.O.); (N.I.); (Y.S.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan;
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan;
- Correspondence: (H.F.); (K.I.); Tel.: +81-476-35-5600 (H.F. & K.I.)
| |
Collapse
|
7
|
Yu L, Li L, Li D, Luo Z, Liu N, Wu Y, Bao D, Cui X. Surgical strategy of lumbopelvic instrumentation in the treatment of lumbosacral tuberculosis: S2-alar-iliac screws vs iliac screws. Int Wound J 2022; 19:1964-1974. [PMID: 35297177 DOI: 10.1111/iwj.13795] [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: 11/02/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to evaluate the feasibility and clinical outcomes of S2-alar-iliac (S2AI) and iliac screw (IS) techniques in the lumbopelvic reconstruction of lumbosacral tuberculosis patients. From January 2014 to August 2016, 26 patients with lumbosacral tuberculosis attending the 8th Medical Centre of Chinese PLA General Hospital were included in this retrospective study. The subjects were divided into two groups based on the lumbopelvic fixation type (16 patients in the S2AI group, 10 patients in the IS group). The operation time, blood loss, length of hospitalisation, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analogue scale (VAS), Oswestry Disability Index (ODI), ambulatory status, and 36-Item Short-Form Health Survey (SF-36) scores of the patients in two groups were recorded and compared. In addition, surgical complications were collected and analysed. The operation time and intraoperative blood loss were significantly lower in the S2AI group than that in the IS group (P < .05). Compared with preoperative data, postoperative data showed significant improvement in ESR, CRP level, ODI scores, VAS scores, ambulatory status, and SF-36 (P < .05), but there was no significant difference in remission degree between the two groups. Compared with IS group, The S2AI group had significantly lower rates of symptomatic screw prominence (P < .05). Both the IS and S2AI fixation techniques can achieve satisfactory outcomes for the restoration of lumbosacral stability of lumbosacral tuberculosis. Furthermore, compared to the traditional IS fixation technique, the S2AI fixation technique can shorten operation time and reduce surgical trauma for the treatment of lumbosacral tuberculosis.
Collapse
Affiliation(s)
- Long Yu
- Department of Orthopedic Surgery, The 4th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Litao Li
- Department of Orthopedic Surgery, The 4th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dawei Li
- Department of Orthopedic Surgery, The 4th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhanpeng Luo
- Department of Orthopedic Surgery, The 4th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ning Liu
- Department of Orthopedic Surgery, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yunfeng Wu
- Department of Orthopedic Surgery, The 4th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Da Bao
- Department of Orthopedic Surgery, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xu Cui
- Department of Orthopedic Surgery, The 4th Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
8
|
Computed Tomography-Based Navigation System in Current Spine Surgery: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58020241. [PMID: 35208565 PMCID: PMC8880580 DOI: 10.3390/medicina58020241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
The number of spine surgeries using instrumentation has been increasing with recent advances in surgical techniques and spinal implants. Navigation systems have been attracting attention since the 1990s in order to perform spine surgeries safely and effectively, and they enable us to perform complex spine surgeries that have been difficult to perform in the past. Navigation systems are also contributing to the improvement of minimally invasive spine stabilization (MISt) surgery, which is becoming popular due to aging populations. Conventional navigation systems were based on reconstructions obtained by preoperative computed tomography (CT) images and did not always accurately reproduce the intraoperative patient positioning, which could lead to problems involving inaccurate positional information and time loss associated with registration. Since 2006, an intraoperative CT-based navigation system has been introduced as a solution to these problems, and it is now becoming the mainstay of navigated spine surgery. Here, we highlighted the use of intraoperative CT-based navigation systems in current spine surgery, as well as future issues and prospects.
Collapse
|
9
|
Matsukawa K, Abe Y, Mobbs RJ. Novel Technique for Sacral-Alar-Iliac Screw Placement Using Three-Dimensional Patient-Specific Template Guide. Spine Surg Relat Res 2021; 5:418-424. [PMID: 34966869 PMCID: PMC8668215 DOI: 10.22603/ssrr.2020-0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The sacral-alar-iliac (SAI) screw technique is becoming popular for sacropelvic fixation. However, appropriately placing SAI screws is technically demanding because of a narrow safe corridor and the risk of neurovascular/visceral injuries. Recently, a three-dimensional patient-specific template guiding technique for pedicle screw placement has been considered a promising method to improve accuracy and safety. The objective of the present study was to investigate the accuracy of SAI screw placement with a patient-specific template guide using cadaveric and prospective clinical pilot studies. Methods Three-dimensional planning of SAI screw placement, including entry point, screw trajectory, length, and diameter, was performed using a computer simulation software. Then, three-dimensional printed patient-specific template guides were created based on the plan. Firstly, a total of 12 SAI screws were placed for 6 cadaveric specimens using the guides. Next, in a prospective clinical trial, a total of 20 SAI screws were placed for 10 consecutively enrolled patients. The safety and accuracy of screw placement were analyzed using postoperative computed tomography by the evaluation of any cortical breach and measurement of screw deviations between the planned and actual screw positions. Results All the screws showed no perforation. In the cadaveric study, the mean horizontal and vertical deviations from the planned screw position at the entry point were 1.40±1.21 mm and 1.34±1.09 mm, respectively. The mean angular deviations in the sagittal and transverse planes were 1.68°±1.24° and 1.53°±1.06°, respectively. The results of the clinical study showed comparable accuracy with those of the cadaveric study, except for the vertical deviation at the entry point (p=0.048). Conclusions This is the first study to evaluate the feasibility and accuracy of using a patient-specific template guide for SAI screw placement. This technique could become an effective solution to achieve accurate screw placement.
Collapse
Affiliation(s)
- Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Japan
| | - Ralph Jasper Mobbs
- Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Level 7, Prince of Wales Private Hospital, Sydney, Australia
| |
Collapse
|
10
|
Campbell DH, McDonald D, Araghi K, Araghi T, Chutkan N, Araghi A. The Clinical Impact of Image Guidance and Robotics in Spinal Surgery: A Review of Safety, Accuracy, Efficiency, and Complication Reduction. Int J Spine Surg 2021; 15:S10-S20. [PMID: 34607916 DOI: 10.14444/8136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Image guidance (IG) and robotic-assisted (RA) surgery are modern technological advancements that have provided novel ways to perform precise and accurate spinal surgery. These innovations supply real-time, three-dimensional imaging information to aid in instrumentation, decompression, and implant placement. Although nothing can replace the knowledge and expertise of an experienced spine surgeon, these platforms do have the potential to supplement the individual surgeon's capabilities. Specific advantages include more precise pedicle screw placement, minimally invasive surgery with less reliance on intraoperative fluoroscopy, and lower radiation exposure to the surgeon and staff. As these technologies have become more widely adopted over the years, novel uses such as tumor resection have been explored. Disadvantages include the cost of implementing IG and robotics platforms, the initial learning curve for both the surgeon and the staff, and increased patient radiation exposure in scoliosis surgery. Also, given the relatively recent transition of many procedures from inpatient settings to ambulatory surgery centers, access to current devices may be cost prohibitive and not as readily available at some centers. Regarding patient-related outcomes, much further research is warranted. The short-term benefits of minimally invasive surgery often bolster the perioperative and early postoperative outcomes in many retrospective studies on IG and RA surgery. Randomized controlled trials limiting such confounding factors are warranted to definitively show potential independent improvements in patient-related outcomes specifically attributable to IG and RA alone. Nonetheless, irrespective of these current unknowns, it is clear that these technologies have changed the field and the practice of spine surgery. Surgeons should be familiar with the potential benefits and tradeoffs of these platforms when considering adopting IG and robotics in their practices.
Collapse
Affiliation(s)
- David H Campbell
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Donnell McDonald
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | | | | | - Norman Chutkan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The CORE Institute, Phoenix, Arizona
| | | |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Triano M, Fayed I, Sandhu FA. Robot-assisted revision of sacroiliac joint fusion using a triangular titanium implant in an S2-alar-iliac trajectory: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE2169. [PMID: 35854956 PMCID: PMC9272365 DOI: 10.3171/case2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sacroiliac joint (SIJ) dysfunction can lead to significant pain and disability, greatly impairing quality of life. Arthrodesis may take up to 1 year to occur, after which revision can be considered. There is a need for highly accurate and reproducible techniques for revision that allow for purchase through undisturbed bone to prevent prolonged pain and disability. Moreover, a minimally invasive technique for revision would be favorable for recovery, particularly in elderly patients. OBSERVATIONS An 84-year-old man with a prior history of lumbar fusion presented with severe buttock pain limiting ambulation and sitting because of the failure of arthrodesis after SIJ fusion 1 year earlier. He underwent revision using a triangular titanium implant (TTI) in an S2-alar-iliac (S2-AI) trajectory under robotic guidance, which is a novel technique not yet described in the literature. The patient’s pain largely resolved, he was able to ambulate independently, and his quality of life improved tremendously. There were no complications of surgery. LESSONS Placement of a TTI using an S2-AI trajectory is a safe and effective method for revision that can be considered for elderly patients. Robot-assisted navigation can be used to facilitate an accurate and reproducible approach using a minimally invasive approach.
Collapse
Affiliation(s)
- Matthew Triano
- Georgetown University School of Medicine, Washington, DC; and
| | - Islam Fayed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Faheem A. Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
13
|
Tatara Y, Niimura T, Sekiya T, Mihara H. Extra-articular Portion of the Sacroiliac Joint-Between the Sacral and Pelvic Tuberosities: An Anatomical Guide for the S2-Alar-Iliac Screw Trajectory. Global Spine J 2021; 11:305-311. [PMID: 32875863 PMCID: PMC8013944 DOI: 10.1177/2192568220903033] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A novel technique for S2-alar-iliac (S2AI) screw placement was analyzed. OBJECTIVES Accurate confirmation of the S2AI screw trajectory with free-hand techniques is not simple, although some anatomical landmarks have been reported. To overcome the drawback, we aimed to introduce our technique for S2AI screw placement assisted with a guidewire using a new anatomical landmark. METHODS A total of 104 S2AI screws of 52 patients who underwent S2AI screw placement were investigated. Navigation software was used to simulate S2AI screw placement preoperatively. Screw placement was performed with the nonfluoroscopic free-hand technique. In this technique, a guidewire is inserted into the ilium from the extra-articular portion of the sacroiliac joint just lateral to the ideal screw entry point toward the tip of the greater trochanter and guides the screw trajectory. If the direction of the guidewire is satisfactory, all procedures of screw insertion are performed accordingly. The screw accuracy was assessed with computed tomography. RESULTS The modal size of the screw was 9.5 mm × 90 mm. The average horizontal angle was 42.0° (SD = 5.1°) on the right and 40.7° (SD = 4.7°) on the left. Of the 104 screws, 4 screws (3.9%) breached dorsally. No screw-related complication was observed. CONCLUSIONS Because the guidewire can be inserted at an angle according to the individual morphology of the sacroiliac joint, it will be a reliable guide for the screw trajectory. This technique with a guidewire would help improve the accuracy of S2AI screw placement.
Collapse
Affiliation(s)
- Yasunori Tatara
- Yokohama Minami Kyosai Hospital, Kanagawa, Japan,Yasunori Tatara, MD, PhD, Spine Center, Yokohama Minami Kyosai Hospital, 1-21 -1 Mutsurahigashi, Kanazawa-ku, Kanagawa, 236-0037, Japan.
| | | | | | | |
Collapse
|
14
|
de Sousa Pontes MD, Ismael LK, Francisco LA, Herrero CFPDS. Description of the Sacropelvic Parameters Measurement Method for S2-alar iliac Screw Insertion. Rev Bras Ortop 2020; 55:702-707. [PMID: 33364647 PMCID: PMC7748935 DOI: 10.1055/s-0040-1713163] [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: 08/24/2019] [Accepted: 02/20/2020] [Indexed: 10/25/2022] Open
Abstract
Objective Description of the sacropelvic parameters measurement method for S2-alar iliac (S2AI) screw insertion. Methods Descriptive study of the method for measuring sacropelvic parameters for the insertion of the S2AI screw using computed tomography (CT). The data evaluated in multiplanar reconstructions were the parameters of the screw trajectory, including length, diameter and angles of the trajectory in the axial and sagittal planes. Results From the sagittal reconstruction, the axis of the series of axial slices is angled three-dimensionally so that it is possible to visualize the S2 vertebra, the screw entry point, and the anteroinferior iliac spine (AIIS) in the same plane. The entry point is demarcated at the midpoint between the dorsal foramina of S1 and S2. To measure the length of the screw, lines are drawn tangent to the inner and outer cortices of the iliac. The diameter is determined by the shortest distance between the inner and outer iliac faces minus half of the diameter of the screw chosen medially and laterally. The path angle in the axial plane is formed by the anteroposterior midline of the sacrum and the line of the screw length. The craniocaudal inclination angle in relation to the S1 plateau corresponds to the degree of inclination made in the sagittal plane to find the image in which the entry point and the AIIS are seen in the same plane. Conclusion It was possible to adequately assess, through multiplanar CT reconstructions, the sacropelvic parameters necessary for the safe insertion of the S2AI screw.
Collapse
Affiliation(s)
- Mariana Demétrio de Sousa Pontes
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor System, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Lucas Klarosk Ismael
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor System, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Lucas Américo Francisco
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor System, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Carlos Fernando Pereira da Silva Herrero
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor System, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| |
Collapse
|
15
|
Ravindra VM, Mazur MD, Brockmeyer DL, Kraus KL, Ropper AE, Hanson DS, Dahl BT. Clinical Effectiveness of S2-Alar Iliac Screws in Spinopelvic Fixation in Pediatric Neuromuscular Scoliosis: Systematic Literature Review. Global Spine J 2020; 10:1066-1074. [PMID: 32875851 PMCID: PMC7645097 DOI: 10.1177/2192568219899658] [Citation(s) in RCA: 2] [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 Systematic literature review. OBJECTIVES To comprehensively review the S2-alar iliac (S2-AI) screw technique for pelvic fixation in pediatric neuromuscular scoliosis. METHODS Articles identified from the PubMed and EMBASE databases were reviewed for relevance and applicability, and the studies were summarized. RESULTS Eight articles met the inclusion criteria. A total of 277 pediatric patients underwent spinopelvic fixation using S2-AI fixation for neuromuscular scoliosis; the mean follow-up was 3 years (range = 0.75-6 years). Six articles had level III evidence (5 retrospective cohort studies, 1 observational study), and 2 articles had level IV evidence (case series). Wound complications occurred in 34 (12.2%) patients. Instrumentation complications occurred in 36 patients (13.0%), including lucency around the screw (6.5%), screw fracture (3.6%), disengaging of the set/screw or rod from the tulip head (2.8%), and screw displacement (0.7%). Three patients (1.1%) required reoperation for instrumentation failures. The overall reoperation rate-including 3 hardware replacements and 3 cases of L5-S1 pseudarthrosis-was 2.1%. The mean Cobb angle correction was 51.4°, and the mean pelvic obliquity correction was 14.8°; deformity correction was maintained at 3- and 5-year follow-ups. There were 10 (3.6%) cases of implant prominence/implant-related pain, 1 case of sacroiliac joint pain (resolved with longer screw placement), and no major neurological or vascular complications secondary to S2-AI screw placement. CONCLUSIONS This review suggests that the use of S2-AI screws in pediatric neuromuscular scoliosis is efficacious with a reasonable safety profile and provides a useful technique for pelvic fixation in children with scoliosis.
Collapse
Affiliation(s)
- Vijay M. Ravindra
- University of Utah, Salt Lake City, UT, USA,Baylor College of Medicine, Houston, TX, USA,Vijay M. Ravindra, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N Medical Drive East, Salt Lake City, UT 84132, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Sasaki Y, Ochiai N, Kotani T, Kenmoku T, Hashimoto E, Kishida S, Sakuma T, Muramatsu Y, Ueno K, Nakayama K, Iijima Y, Minami S, Ohtori S. Clinical application of intraoperative O-arm navigation in reverse shoulder arthroplasty. J Orthop Sci 2020; 25:836-842. [PMID: 31864765 DOI: 10.1016/j.jos.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Inaccurate fixation and positioning of the glenoid component using conventional techniques are problematic in reversed shoulder arthroplasty (RSA). Our objective was to investigate the accuracy of O-arm navigation of the glenoid component in RSA. METHODS This retrospective case-control study comprised 2 groups of 25 patients who underwent reversed shoulder arthroplasty with or without intraoperative O-arm navigation. The intraoperative goal was to place the component neutrally in the glenoid in the axial plane and 10° inferiorly tilted in the scapular plane. Glenoid version angle and inclination were measured by computed tomography obtained preoperatively and a year postoperatively. Operative time, intraoperative bleeding, and the presence of postoperative complications were recorded. RESULTS Compared with the ideal, the range of error for version was 7.3° (SD 3.6°) in the control group and 5.6° (SD 3.6°) in the navigated group (P = 0.278), and the range of error for inclination was 18.3° (SD 11.7°) in the control group and 4.9° (SD 3.8°) in the navigated group (P = 0.0004). The mean operative time was 164.6 (SD 21.2) min in the control group and 192.0 (SD 16.2) min in the navigated group (P = 0.001). The mean intraoperative bleeding was 201.0 (SD 37.0) mL in the control group and 185.3 (SD 35.6) mL in the navigated group (P = 0.300). There were no complications reported related to the intraoperative O-arm navigation. CONCLUSION O-arm navigation may be a useful tool for the placement with inferior tilt of the glenoid procedure in reversed shoulder arthroplasty.
Collapse
Affiliation(s)
- Yu Sasaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan.
| | - Nobuyasu Ochiai
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Tomonori Kenmoku
- Department of Orthopedics Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Eiko Hashimoto
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shunji Kishida
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Yuta Muramatsu
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Keisuke Ueno
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Keita Nakayama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Seiji Ohtori
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| |
Collapse
|
17
|
Tamaki R, Wada K, Okazaki K. Surgical Technique and Accuracy of S2 Alar-Iliac Screw Insertion Using Intraoperative O-Arm Navigation: An Analysis of 120 Screws. World Neurosurg 2020; 144:e326-e330. [PMID: 32841800 DOI: 10.1016/j.wneu.2020.08.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the surgical technique and accuracy of S2 alar-iliac (SAI) screw placement using intraoperative O-arm-based 3-dimensional navigation (O-arm). METHODS This study involved 60 patients who underwent SAI screw placement using the O-arm system between September 2013 and September 2019. These surgeries were performed by 5 different surgeons. For O-arm-based SAI screw insertion, a reference frame was attached to the spinous process of the lower lumbar spine (usually L4) so as not to interfere with SAI screw insertion and to facilitate simultaneous L5-S posterior interbody fusion with navigation. The navigated probe, iliac tap, and screwdriver were used for SAI screw insertion. Screw placement accuracy and screw length were assessed using postoperative computed tomography. Perioperative complications were also evaluated. RESULTS Mean age at surgery was 68.1 (range, 30-83) years. In total, 120 screws were inserted. Rate of accurate screw placement was 98.3% (118/120 screws). The 2 misplaced screws breached the anterior cortex of the sacrum. Mean screw length was 85.6 (range, 70-90) mm. There were no significant neurovascular or visceral complications perioperatively. CONCLUSIONS SAI screw placement can be safely performed using the intraoperative O-arm system and our surgical technique.
Collapse
Affiliation(s)
- Ryo Tamaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiji Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
18
|
Hyun SJ, Jung JM, Kim KJ, Jahng TA. Durability and Failure Types of S2-Alar-Iliac Screws: An Analysis of 312 Consecutive Screws. Oper Neurosurg (Hagerstown) 2020; 20:91-97. [DOI: 10.1093/ons/opaa251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Abstract
BACKGROUND
S2-alar-iliac (S2AI) screws improve stability across the lumbosacral junction in spinopelvic fixation procedures by crossing the cortical surfaces of the sacroiliac joint (SIJ), thereby increasing the biomechanical strength of the instrumentation.
OBJECTIVE
To investigate the durability and failure types of S2AI screws after spinopelvic reconstruction surgery.
METHODS
A single-center, single-surgeon consecutive series of patients who underwent spinopelvic fixation using bilateral S2AI screws with a ≥1-yr follow-up and at least 1 postoperative computed tomographic scan were retrospectively reviewed. Patient characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed.
RESULTS
In total, 312 S2AI screws in 156 patients were evaluated (mean follow-up, 26.1 mo; range 12-71 mo). There were no significant differences in screw diameter, length, or insertion angle between right-side and left-side screws. Visual analogue scale scores for back pain, ambulatory status, and Oswestry Disability Index scores significantly improved. A total of 10 patients (3.2%) experienced SIJ pain after S2AI screw installation. SIJ pain improved in 8 of them following SIJ block. In total, 7 screws (2.2%) showed partial periscrew lucency. Set screw dislodgement occurred in 7 screws (2.2%). Screw fracture occurred in 6 screws (1.9%): 5 neck fractures and 1 shaft fracture. A total of 5 patients (1.6%) underwent revision surgery for S2AI screw failure. Distal device (L4-pelvis region) breakage occurred in 5 patients.
CONCLUSION
The radiographic and clinical outcomes of S2AI screw fixation were acceptable. However, S2AI screw fixation has several drawbacks, including screw fracture and dislodgement of the set screw. SIJ irritation symptoms after S2AI screw fixation occurred with considerable frequency.
Collapse
Affiliation(s)
- Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jong-myung Jung
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
19
|
Pelvic parameters directly influence ideal S2 alar-iliac (S2AI) screw trajectory. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2020; 2:100014. [PMID: 35141584 PMCID: PMC8819910 DOI: 10.1016/j.xnsj.2020.100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/24/2022]
|
20
|
Hartensuer R, Grüneweller N, Lodde MF, Evers J, Riesenbeck O, Raschke M. The S2-Alar-Iliac Screw for Pelvic Trauma. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:522-532. [PMID: 32659833 DOI: 10.1055/a-1190-5987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Percutaneous sacro-iliac screw osteosynthesis is considered to be standard of care for most posterior pelvic ring fractures. However, special situations require alternative strategies for sufficient stabilization. In these cases, stabilization can often be achieved using posterior instrumentation e.g. using SIPS-screws (spina-iliaca-posterior-superior screws). However, this often leads to implant-related aggravation of the sometimes already critical soft tissue conditions after pelvic trauma. S2-Ala-Ilium screws (S2AI screws) are a suitable alternative. The starting point lies medial of the posterior superior iliac spine below the iliac level. It is almost in line with a potential spinal instrumentation and therefore usually causes fewer soft tissue problems. Although this technique has been widely used in spinal surgery in recent years, its use in orthopaedic traumatology is largely unknown. The possibilities but also the limitations of this technique for the treatment of injuries to the pelvis are illustrated by this retrospective case series.
Collapse
Affiliation(s)
- Rene Hartensuer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | - Niklas Grüneweller
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | | | - Julia Evers
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | - Oliver Riesenbeck
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| | - Michael Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
| |
Collapse
|
21
|
Hasan MY, Liu G, Wong HK, Tan JH. Postoperative complications of S2AI versus iliac screw in spinopelvic fixation: a meta-analysis and recent trends review. Spine J 2020; 20:964-972. [PMID: 31830594 DOI: 10.1016/j.spinee.2019.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Iliac screw constructs have been a major advancement in spinopelvic fixation demonstrating superior biomechanics as compared with earlier pelvic spanning constructs. However, drawbacks such as screw site prominence and wound complication have led to the development of a lower profile S2AI iliac screw. PURPOSE In this study, we aimed to study the differences in complication rates between the traditional iliac and S2AI fixations via a pooled analysis of the available head-to-head comparisons between S2AI and iliac screws. We also aimed to study the iliac screw complications trend over the years particularly with reference to recent modifications in its screw insertion techniques. STUDY DESIGN A meta-analysis with attention to the comparison of patients who underwent iliac screws and S2AI screws was conducted. METHODS The following databases were utilized: PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials database. Using the search terms: iliac, iliac bolts, S2AI, sacral 2 alar iliac, sacral two alar iliac, reviewers independently selected eligible studies, analyzed data and evaluated the risk of bias. Data analysis was conducted using RevMan 5.3 software. RESULT A total of 215 articles were identified, with 6 clinical studies directly comparing outcomes of S2AI pelvic fixation versus iliac screw fixation. A total of 477 patients were included, of which 255 patients (53.5%) underwent S2AI screw and 222 (46.5%) underwent iliac screw fixation. Our pooled analysis favored S2AI screws with regards to postoperative complications of screw prominence (odds ratio [OR]=5.99, 95% confidence interval [CI]=2.168-16.523, p<.001), screw loosening (OR=3.36, 95% CI=1.415-7.998, p=.006), implant breakage (OR=2.30, 95% CI=1.189-4.443, p=.013), and revision surgery (OR=7.84, 95% CI=3.224-19.080, p<.001). Although there was a trend toward more wound complications in conventional iliac screw techniques when compared with S2AI, it was not statistically significant. CONCLUSION Spinopelvic fixation is an evolving technique. The results from this study showed that S2AI screws with a lower profile have made a significant impact in reducing complications associated with conventional iliac screws. With recent entry point modification and further advancement in the conventional iliac screw technique, such as the "subcrestal iliac screw technique" which reduces the iliac screw complication rate but avoids S2AI-associated SIJ violation. Further studies may be needed to investigate whether these newer iliac screw techniques can narrow the difference in complication rates between iliac screws and S2AI screw techniques.
Collapse
Affiliation(s)
- Muhammed Yaser Hasan
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Gabriel Liu
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore.
| | - Hee-Kit Wong
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Jun-Hao Tan
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore
| |
Collapse
|
22
|
Kochanski RB, Lombardi JM, Laratta JL, Lehman RA, O'Toole JE. Image-Guided Navigation and Robotics in Spine Surgery. Neurosurgery 2020; 84:1179-1189. [PMID: 30615160 DOI: 10.1093/neuros/nyy630] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/04/2018] [Indexed: 01/27/2023] Open
Abstract
Image guidance (IG) and robotics systems are becoming more widespread in their utilization and can be invaluable intraoperative adjuncts during spine surgery. Both are highly reliant upon stereotaxy and either pre- or intraoperative radiographic imaging. While user-operated IG systems have been commercially available longer and subsequently are more widely utilized across centers, robotics systems provide unique theoretical advantages over freehand and IG techniques for placing instrumentation within the spine. While there is a growing plethora of data showing that IG and robotic systems decrease the incidence of malpositioned screws, less is known about their impact on clinical outcomes. Both robotics and IG may be of particular value in cases of substantial deformity or complex anatomy. Indications for the use of these systems continue to expand with an increasing body of literature justifying their use in not only guiding thoracolumbar pedicle screw placement, but also in cases of cervical and pelvic instrumentation as well as spinal tumor resection. Both techniques also offer the potential benefit of reducing occupational exposures to ionizing radiation for the operating room staff, the surgeon, and the patient. As the use of IG and robotics in spine surgery continues to expand, these systems' value in improving surgical accuracy and clinical outcomes must be weighed against concerns over cost and workflow. As newer systems incorporating both real-time IG and robotics become more utilized, further research is necessary to better elucidate situations where these systems may be particularly beneficial in spine surgery.
Collapse
Affiliation(s)
- Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph M Lombardi
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Joseph L Laratta
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
23
|
Nanda A, Manghwani J, Kluger PJ. Sacropelvic fixation techniques - Current update. J Clin Orthop Trauma 2020; 11:853-862. [PMID: 32879572 PMCID: PMC7452281 DOI: 10.1016/j.jcot.2020.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
Sacropelvic is a complex junctional area owing to the complex regional anatomy and higher biomechanical stress. However extension of construct is indicated in cases with complex deformities, high grade spondylolisthesis, and complex fractures. The challenges remain which includes pseudoarthrosis and fixation failures. The fixation techniques have constantly evolved over time with better results with iliac screws and S2-alar-iliac screws. This article gives background on evolution, biomechanics, and recent update of use of robotics for sacropelvic fixation.
Collapse
Affiliation(s)
- Ankur Nanda
- Indian Spinal Injuries Centre, New Delhi, 110070, India
| | - Jitesh Manghwani
- Indian Spinal Injuries Centre, New Delhi, 110070, India,Corresponding author.
| | | |
Collapse
|
24
|
Galetta MS, Leider JD, Divi SN, Goyal DKC, Schroeder GD. Robotics in spinal surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S165. [PMID: 31624731 DOI: 10.21037/atm.2019.07.93] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although the da Vinci robot system has garnered much attention in the realm of surgery over the past few decades, several new surgical robotic systems have been developed for spinal surgery with varying levels of robot autonomy and surgeon-specified input. These devices are currently being considered as potential avenues for increasing the precision of any surgical intervention. The following review will attempt to provide an overview of robotics in modern spine surgery and how these devices will continue to be employed in various sectors across the field.
Collapse
Affiliation(s)
- Matthew S Galetta
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph D Leider
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
25
|
Nguyen JH, Buell TJ, Wang TR, Mullin JP, Mazur MD, Garces J, Taylor DG, Yen CP, Shaffrey CI, Smith JS. Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up. J Neurosurg Spine 2019; 30:635-643. [PMID: 30717036 DOI: 10.3171/2018.9.spine18239] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent literature describing complications associated with spinopelvic fixation with iliac screws in adult patients has been limited but has suggested high complication rates. The authors' objective was to report their experience with iliac screw fixation in a large series of patients with a 2-year minimum follow-up. METHODS Of 327 adult patients undergoing spinopelvic fixation with iliac screws at the authors' institution between 2010 and 2015, 260 met the study inclusion criteria (age ≥ 18 years, first-time iliac screw placement, and 2-year minimum follow-up). Patients with active spinal infection were excluded. All iliac screws were placed via a posterior midline approach using fluoroscopic guidance. Iliac screw heads were deeply recessed into the posterior superior iliac spine. Clinical and radiographic data were obtained and analyzed. RESULTS Twenty patients (7.7%) had iliac screw-related complication, which included fracture (12, 4.6%) and/or screw loosening (9, 3.5%). No patients had iliac screw head prominence that required revision surgery or resulted in pain, wound dehiscence, or poor cosmesis. Eleven patients (4.2%) had rod or connector fracture below S1. Overall, 23 patients (8.8%) had L5-S1 pseudarthrosis. Four patients (1.5%) had fracture of the S1 screw. Seven patients (2.7%) had wound dehiscence (unrelated to the iliac screw head) or infection. The rate of reoperation (excluding proximal junctional kyphosis) was 17.7%. On univariate analysis, an iliac screw-related complication rate was significantly associated with revision fusion (70.0% vs 41.2%, p = 0.013), a greater number of instrumented vertebrae (mean 12.6 vs 10.3, p = 0.014), and greater postoperative pelvic tilt (mean 27.7° vs 23.2°, p = 0.04). Lumbosacral junction-related complications were associated with a greater mean number of instrumented vertebrae (12.6 vs 10.3, p = 0.014). Reoperation was associated with a younger mean age at surgery (61.8 vs 65.8 years, p = 0.014), a greater mean number of instrumented vertebrae (12.2 vs 10.2, p = 0.001), and longer clinical and radiological mean follow-up duration (55.8 vs 44.5 months, p < 0.001; 55.8 vs 44.6 months, p < 0.001, respectively). On multivariate analysis, reoperation was associated with longer clinical follow-up (p < 0.001). CONCLUSIONS Previous studies on iliac screw fixation have reported very high rates of complications and reoperation (as high as 53.6%). In this large, single-center series of adult patients, iliac screws were an effective method of spinopelvic fixation that had high rates of lumbosacral fusion and far lower complication rates than previously reported. Collectively, these findings argue that iliac screw fixation should remain a favored technique for spinopelvic fixation.
Collapse
|
26
|
Tavares Junior MCM, de Souza JPV, Araujo TPF, Marcon RM, Cristante AF, de Barros Filho TEP, Letaif OB. Comparative tomographic study of the S2-alar-iliac screw versus the iliac screw. 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 2018; 28:855-862. [PMID: 30382431 DOI: 10.1007/s00586-018-5806-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
AIMS Iliac screws and S2-alar-iliac screws provide adequate mechanical stability for the fixation of lumbosacral spine pathologies, which has led to a significant increase in the use of these techniques in the routine practice of spine surgeons. However, studies on the ideal technical positioning for both techniques are limited. STUDY DESIGN This is an observational, retrospective, analytical descriptive study. OBJECTIVE To analyze, describe and compare the insertion and positioning parameters of the S2-alar-iliac and iliac screw techniques in adult patients without spinal deformities. METHODS The present study comprises a retrospective analysis of lumbosacral computed tomography images selected continuously in 2016 from 25 patients at a university hospital. Mann-Whitney-Shapiro-Wilk tests were performed. Data reliability was assessed using intraclass correlation. RESULTS The mean length of the iliac screw was greater than that of the S2-alar-iliac screw, and the S2-alar-iliac screw sat 20.5 mm deeper than the iliac screw. The mean of the greatest bone thickness for the iliac screw was 20.72 mm; that of the S2-alar-iliac screw was 23.24 mm. The mean distance from the iliac screw entry point to the skin was 32.46 mm, and the mean distance from the S2-alar-iliac screw entry point to the skin was 52.87 mm. CONCLUSION The trajectory of the S2-alar-iliac screws studied via computed tomography was greater in terms of bone thickness and deeper relative to the skin compared with the iliac screws. The S2-alar-iliac technique may have desirable clinical advantages in terms of the diameter of the screws and reduced protrusion when used in adults. These slides can be retrieved from Electronic supplementary material.
Collapse
Affiliation(s)
| | - João Paço Vaz de Souza
- Department of Orthopedics and Traumatology, IOT HCFMUSP, 171 Dr. Ovídio Pires de Campos St., São Paulo, SP, 05403010, Brazil
| | | | - Raphael Martus Marcon
- Department of Orthopedics and Traumatology, IOT HCFMUSP, 171 Dr. Ovídio Pires de Campos St., São Paulo, SP, 05403010, Brazil
| | - Alexandre Fogaça Cristante
- Department of Orthopedics and Traumatology, IOT HCFMUSP, 171 Dr. Ovídio Pires de Campos St., São Paulo, SP, 05403010, Brazil
| | | | - Olavo Biraghi Letaif
- Department of Orthopedics and Traumatology, IOT HCFMUSP, 171 Dr. Ovídio Pires de Campos St., São Paulo, SP, 05403010, Brazil
| |
Collapse
|
27
|
Abstract
Fixation at the lumbosacral junction continues to be a challenge for spine surgeons despite advances in spinal instrumentation techniques. The poor bone quality of the sacrum, the complex regional anatomy, and the tremendous biomechanical forces at the lumbosacral junction contribute to the high rates of instrumentation-related complications. Although many spinopelvic fixation techniques have been reported, only a few are still widely used because of the high complication rates associated with previous techniques. Spinopelvic fixation has numerous indications. Long-segment lumbar and thoracolumbar fusions to the sacrum are the most common scenarios in which instrumentation is extended to the pelvis. Surgeons performing complex spinal reconstruction should be familiar with the available techniques, including their potential risks and complications.
Collapse
|
28
|
Vilela MD, Braga BP, Pedrosa HAS. Fluoroscopy only for the placement of long iliac screws: A study on 14 patients. Surg Neurol Int 2018; 9:108. [PMID: 29930874 PMCID: PMC5991264 DOI: 10.4103/sni.sni_59_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/14/2018] [Indexed: 11/04/2022] Open
Abstract
Background Iliac screw placement is challenging due to the particular anatomy of the ilium. Most series have reported the use of relatively short (≤90 mm in length) screws despite a long iliac buttress, which has an average length of 129 mm in females and 141 mm in males. This study describes a series of 14 patients who underwent placement of long iliac screws (≥100 mm in length) as part of a spinopelvic fusion utilizing fluoroscopy alone. Methods All patients who received at least one long iliac screw were included in this study. Placement accuracy, the average distance from the screw tip to the anterior inferior iliac spine (AIIS), neurovascular injuries, acetabulum and/or sciatic notch violations, and screw prominence were all measured. Results Fourteen patients received 38 iliac screws, with 31 screws being ≥100 mm in length. The accuracy rate was 87.1% (27/31) for the long iliac screws. The average shortest distance from the iliac screw tip to the AIIS was 15.5 mm for the right-sided and 17.1 mm for the left-sided ilia. There were no neurovascular injuries, acetabulum, or sciatic notch violations, and no screws loosened or fractured. Of interest, only one patient required off-set connectors to link the rods to the iliac screws. Conclusions Placement of long iliac screws under intraoperative fluoroscopy only was shown to be feasible, with a high accuracy rate and few complications, in this series of patients.
Collapse
Affiliation(s)
- Marcelo D Vilela
- Department of Neurosurgery, Hospital Mater Dei, Belo Horizonte, Brazil.,Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Bruno P Braga
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Hugo A S Pedrosa
- Department of Neurosurgery, Hospital Mater Dei, Belo Horizonte, Brazil.,Department of Neurosurgery, Benjamin Guimarães Foundation, Belo Horizonte, Brazil
| |
Collapse
|
29
|
Yamada K, Abe Y, Satoh S. Safe insertion of S-2 alar iliac screws: radiological comparison between 2 insertion points using computed tomography and 3D analysis software. J Neurosurg Spine 2018; 28:536-542. [PMID: 29451435 DOI: 10.3171/2017.8.spine17735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE S-2 alar iliac (S2AI) screws are commonly used as anchors for lumbosacral fixation. A serious potential complication of screw insertion is major vascular injury due to anterior or caudal screw deviation. To avoid screw deviation, the pelvic inlet view on intraoperative fluoroscopy images is recommended. However, there has been no detailed investigation of optimal fluoroscopic incline with the pelvic inlet view. The purpose of this study was to investigate the safety margins and to optimize fluoroscopic settings to avoid screw deviation with 2 reported insertion techniques using 3D analysis software and CT. METHODS The study included 50 patients (25 men and 25 women) who underwent abdominal-pelvic CT. With the use of software, the ideal S2AI screws were set from 2 entry points: A) the midpoint between the S-1 dorsal foramen and the S-2 dorsal foramen where they meet the lateral sacral crest, and B) 1 mm inferior and 1 mm lateral to the S-1 dorsal foramen. Anteriorly or caudally deviated screws were defined as deviation of a half thread of the ideal screw by rotation anteriorly or caudally from the entry point. The angular safety margins were compared between the 2 entry points, and patients with small safety margins were investigated. Subsequently, fluoroscopic images were virtualized on ray sum-rendered images. Conditions that provided proper recognition of screw deviation were investigated via lateral and anteroposterior views with the beam tilted caudally. RESULTS The safety margins of S2AI screws were smaller in the anterior direction than in the caudal direction and by entry point A than by entry point B (A: 9.1° ± 1.6° and B: 9.7° ± 1.5° in the anterior direction; A: 10.9° ± 3.8° and B: 13.9° ± 4.1° in the caudal direction). In contrast, patients with a deep-seated L-5 vertebral body tended to have smaller safety margins in the caudal direction. All anteriorly deviated screws were recognized with a 60°-70° inlet view from the S-1 slope. The caudally deviated screws were all recognized on the lateral view, but 31% of screws at entry point A and 21% of screws at entry point B were not recognized on the pelvic inlet view. CONCLUSIONS S2AI screws should be carefully placed to avoid anterior deviation compared with caudal deviation in terms of the safety margin, except in patients with a deep-seated L-5. The difference in safety margins between entry points A and B was negligible. Intraoperative fluoroscopy is recommended with a pelvic inlet view tilted 60°-70° from the S-1 slope to avoid anterior screw deviation. The lateral view is recommended to confirm that the screw is not deviated caudally.
Collapse
Affiliation(s)
- Kentaro Yamada
- 1Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido; and.,2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Yuichiro Abe
- 1Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido; and
| | - Shigenobu Satoh
- 1Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido; and
| |
Collapse
|
30
|
Mazur MD, Mahan MA, Shah LM, Dailey AT. Fate of S2-Alar-Iliac Screws After 12-Month Minimum Radiographic Follow-up: Preliminary Results. Neurosurgery 2017; 80:67-72. [PMID: 27341341 DOI: 10.1227/neu.0000000000001322] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 05/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND S2-alar-iliac (S2AI) screws are 1 technique for lumbopelvic fixation to improve fusion rates across the lumbosacral junction that has gained wider acceptance. The S2AI screw crosses the cortical surfaces of the sacroiliac joint (SIJ), which may improve the biomechanical strength of the instrumentation. OBJECTIVE To report preliminary radiographic outcomes of patients who underwent lumbopelvic fixation with S2AI screws with a minimum 12-month follow-up. METHODS We retrospectively reviewed adult patients who underwent lumbopelvic fixation with S2AI screws. Patients with computed tomography (CT) scans obtained preoperatively and ≥12 months postoperatively were reviewed to determine whether there was S2AI screw backout or breakage, periscrew lucency, or SIJ degeneration, and to assess L5-S1 fusion status. RESULTS Twenty-six S2AI screws in 13 patients were evaluated (mean follow-up 24.8 months [14-52 months]). Nine patients had L5-S1 interbody grafts. Partial periscrew lucency was identified in 7 S2AI screws (27%) in 5 patients (38%), and L5-S1 fusion occurred in 92% of patients. L5-S1 nonunion was seen in 1 patient (8%), who had evidence of bilateral screw loosening in the sacral portion. Four patients with screw loosening had an osseous L5-S1 fusion. No patients had radiographic evidence of progression of SIJ degeneration, experienced screw backout or breakage, required reoperation for L5-S1 nonunion, or had S2AI screw-related complication. CONCLUSION S2AI screws maintained their integrity without causing SIJ degeneration or major screw-related complications in this small retrospective series with short follow-up. Long-term results are needed to evaluate the durability of S2AI screws over time.
Collapse
Affiliation(s)
- Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Lubdha M Shah
- Department of Radiology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| |
Collapse
|
31
|
Ishida W, Elder BD, Holmes C, Lo SFL, Goodwin CR, Kosztowski TA, Bydon A, Gokaslan ZL, Wolinsky JP, Sciubba DM, Witham TF. Comparison Between S2-Alar-Iliac Screw Fixation and Iliac Screw Fixation in Adult Deformity Surgery: Reoperation Rates and Spinopelvic Parameters. Global Spine J 2017; 7:672-680. [PMID: 28989847 PMCID: PMC5624376 DOI: 10.1177/2192568217700111] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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 cohort study. OBJECTIVE The S2-alar-iliac (S2AI) technique has been described as an alternative method for pelvic fixation in place of iliac screws (ISs) in spinal deformity surgery. The objective of this study was to analyze the impact of S2AI screws on radiographical outcomes, including spinopelvic parameters. METHODS A retrospective review of 17 patients receiving ISs and 46 patients receiving S2AI screws for correction of adult spinal deformity between 2010 and 2015 with minimum 1-year follow-up was conducted. Patient data on postoperative complications, including reoperation rates and proximal junctional kyphosis (PJK), and radiographical parameters was collected and statistically analyzed. RESULTS With mean follow-up of 21.1 months, the overall reoperation rate was significantly lower in the S2AI group than in the IS group (21.7% vs 58.8%, P = .01), but the incidence of PJK was similar (32.6% vs 35.3%, P > .99). Moreover, the time to reoperation in the IS group was significantly shorter than in the S2AI group (P = .001), and the S2AI group trended toward a longer time to reoperation due to PJK (P = .08). There was a significantly higher change in pelvic incidence (PI) in the S2AI group (-6.0°) compared with the IS group (P = .001). CONCLUSIONS Compared with the IS technique, the S2AI technique demonstrated a lower rate of overall reoperation, a similar rate of PJK, longer time to reoperation, and possible reduction in PI. Future studies may be warranted to clarify the mechanism of these results and how they can be translated into improved patient care.
Collapse
Affiliation(s)
- Wataru Ishida
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA,These authors contributed equally to the article
| | - Benjamin D. Elder
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA,These authors contributed equally to the article.,Benjamin D. Elder, Department of Neurological Surgery, Mayo Clinic, 200 1st SW, Rochester, MN 55905, USA.
| | - Christina Holmes
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng-Fu L. Lo
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - C. Rory Goodwin
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ali Bydon
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
32
|
Phan K, Li J, Giang G, Teng I, Phan S, Chang N, Mobbs R. A novel technique for placement of sacro-alar-iliac (S2AI) screws by K-wire insertion using intraoperative navigation. J Clin Neurosci 2017; 45:324-327. [PMID: 28890028 DOI: 10.1016/j.jocn.2017.08.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 08/04/2017] [Accepted: 08/17/2017] [Indexed: 11/17/2022]
Abstract
Sacral-iliac fixation techniques may be indicated in the management of various lumbosacral pathologies including spinal degeneration, infection, tumour resection, fracture, pseudarthrosis, correction of spinal deformities involving long fusion constructs to the sacrum and cases with poor sacral fixation. There are a number of options for lumbosacral fixation each with their own advantages and disadvantages. Though S2-alar-iliac (S2AI) have demonstrated promising advantages over alternatives, the complex anatomy of the spinopelvic region demands precise insertion of the screws to create a biomechanically robust construct safely. As such, we present a novel technique of using intra-operative CT navigation and K-wires to establish and secure a planned trajectory, thereby ensuring solid spinopelvic fixation with S2AI screws. This was performed as part of a long fusion construct for correction of kyphosis deformity in a male patient.
Collapse
Affiliation(s)
- Kevin Phan
- University of New South Wales, Faculty of Medicine, Australia; Neurospine Research Group (NSURG), Australia; University of Sydney, Faculty of Medicine, Australia.
| | - Julian Li
- University of New South Wales, Faculty of Medicine, Australia; Neurospine Research Group (NSURG), Australia.
| | - Gloria Giang
- University of New South Wales, Faculty of Medicine, Australia; Neurospine Research Group (NSURG), Australia.
| | - Ian Teng
- University of New South Wales, Faculty of Medicine, Australia; Neurospine Research Group (NSURG), Australia.
| | - Steven Phan
- Neurospine Research Group (NSURG), Australia; University of Sydney, Faculty of Medicine, Australia.
| | - Nicholas Chang
- University of New South Wales, Faculty of Medicine, Australia.
| | - Ralph Mobbs
- University of New South Wales, Faculty of Medicine, Australia; Neurospine Research Group (NSURG), Australia.
| |
Collapse
|
33
|
Use of S2-Alar-iliac Screws Associated With Less Complications Than Iliac Screws in Adult Lumbosacropelvic Fixation. Spine (Phila Pa 1976) 2017; 42:E142-E149. [PMID: 27254657 DOI: 10.1097/brs.0000000000001722] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To compare clinical and radiographic outcomes between the S2-alar-iliac (S2AI) and the iliac screw (IS) techniques in the adult population and clarify the clinical strength of S2AI screws. SUMMARY OF BACKGROUND DATA S2AI screws have been described as an alternative method for lumbosacropelvic fixation in place of ISs. The S2AI technique has several advantages with lower prominence, increased ability to directly connect to proximal instrumentation, less extensive dissection of tissue, and enhanced biomechanical strength over the IS technique. However, the clinical significance of these advantages remains unclear. METHODS A single-center retrospective review of patients who underwent lumbosacropelvic fixation yielded 25 IS group patients and 65 S2AI group patients. Baseline demographic information, postoperative complications, pain and functional outcomes, and screw-related outcomes were collected. RESULTS The S2AI group had lower rates of reoperation (8.8% vs. 48.0%, P < 0.001), surgical site infection (SSI) (1.5% vs. 44.0%, P < 0.001), wound dehiscence (1.5% vs. 36.0%, P < 0.001), and symptomatic screw prominence (0.0% vs. 12.0%, P = 0.02) than the IS group, whereas rates of L5-S1 pseudarthrosis, proximal junctional failure, and sacroiliac joint pain were similar in both groups. Statistically significant pain relief and functional recovery were achieved in both groups without any significant intergroup differences. On multivariate analyses, age [odds ratio (OR) = 0.91, P = 0.004] and S2AI instrumentation (OR = 0.08, P < 0.001) were protective of reoperation, whereas diabetes mellitus (OR = 10.9, P = 0.03) and preoperative diagnosis of tumor (OR = 12.3, P = 0.04) were associated with SSI, and S2AI instrumentation (OR = 0.09, P < 0.001) was protective of SSI. CONCLUSION The use of the S2AI technique over the IS technique was an independent predictor of preventing reoperation and SSI, while achieving similar clinical and functional outcomes. LEVEL OF EVIDENCE 4.
Collapse
|
34
|
Falzarano G, Rollo G, Bisaccia M, Pace V, Lanzetti RM, Garcia-Prieto E, Pichierri P, Meccariello L. Percutaneous screws CT guided to fix sacroiliac joint in tile C pelvic injury. Outcomes at 5 years of follow-up. SICOT J 2016; 4:52. [PMID: 30480543 PMCID: PMC6256968 DOI: 10.1051/sicotj/2018047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction: The treatment of the sacroiliac joint (SIJ) vertical instability is a matter of current discussions and remains controversial. The aim of our study is the evaluation of the surgical management of SIJ vertical instability involving the use of cannulated screws introduced under CT guidance and local anesthesia. Materials and methods: In the set time frame of 7 years, 96 poly-trauma patients with Tile's type C fracture of the pelvis with vertical instability of the SIJ were treated. The average distance between the two stumps was 73.4 mm (range: 43–100 mm). All patients were treated with anterior stabilization and subsequent stabilization with cannulated screws (Asnis® Stryker® 6 mm, an average length of 70 mm; range from 55 to 85 mm) of the sacroiliac fracture. The clinical and radiological follow-up was performed with follow-up plain radiograph and Majeed score (from 1 to 60 months after injury). Results: The consolidation of pelvic fractures was obtained after an average of 63 days. The average Majeed score was as follows: 96 points at 1 month, 84 points at 3 months, 62 points at 6 months, 44 points at 12 months, 42 points at 24 months, 32 points at 36 months, 28 points at 48 months and 28 points at 60 months. Complications were as follows: not fatal deep vein thrombosis in five cases, skin infection at the entry point of the screws in six cases, screw breakage in one case and loosening of the screws in one case. Radiological evidence of fracture consolidation was achieved on average at 63 days. Forty-seven patients managed to get back to their pre-trauma employment at the end of the convalescence period. Conclusions: Our results suggest that the stabilization of SI Tile type C fracture/dislocations with CT-guided percutaneous cannulated screws is a valid and feasible management option and associated with a low complication rate.
Collapse
Affiliation(s)
- Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Valerio Pace
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia" Hospital, Perugia, Italy - Department of Trauma and Orthopaedics, The Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Riccardo Maria Lanzetti
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Esteban Garcia-Prieto
- Department of Orthopaedics, "Hospital General de Villalba", 28400 Collado Villalba Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| |
Collapse
|
35
|
Ishida W, Elder BD, Holmes C, Goodwin CR, Lo SFL, Kosztowski TA, Bydon A, Gokaslan ZL, Wolinsky JP, Sciubba DM, Witham TF. S2-Alar-Iliac Screws are Associated with Lower Rate of Symptomatic Screw Prominence than Iliac Screws: Radiographic Analysis of Minimal Distance from Screw Head to Skin. World Neurosurg 2016; 93:253-60. [DOI: 10.1016/j.wneu.2016.06.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022]
|
36
|
Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: feasibility and accuracy. 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 2016; 26:720-725. [PMID: 27272491 DOI: 10.1007/s00586-016-4639-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To review our experience with robotic guided S2-alar iliac (S2AI) screw placement. METHODS We retrospectively reviewed patients who underwent S2AI fixation with robotic guidance. Screw placement and deviation from the preoperative plan were assessed by fusing preoperative CT (with the planned S2AI screws) to postoperative CT. The software's measurement tool was used to compare the planned vs. actual screw placements in axial and lateral views, at entry point to the S2 pedicle and at a 30 mm depth at the screws' mid-shaft, in a resolution of 0.1 mm. Medical charts were reviewed for technical issues and intra-operative complications. RESULTS 35 S2AI screws were reviewed in 18 patients. The patients' mean age was 60 years. No intra-operative complications that related to the placement of S2AI screws were reported and robotic guidance was successful in all 35 screws. Post-operative CT scans showed that all trajectories were accurate. No violations of the iliac cortex or breaches of the anterior sacrum were noted. At the entry point, the screw deviated from the pre-operative plan by 3.0 ± 2.2 mm in the axial plane and 1.8 ± 1.6 mm in the lateral plane. At 30 mm depth, the screw deviated from the pre-operative plan by 2.1 ± 1.3 mm in the axial plane and 1.2 ± 1.1 mm in the lateral plane. CONCLUSIONS Robotic guided S2AI screw placement is feasible and accurate. No screw malpositions or complications that related to the placement of S2AI screws occurred in this series. Larger studies are needed to assess the long-term clinical outcomes of robotic guided sacral-pelvic fixation.
Collapse
|
37
|
Liu Z, Jin M, Qiu Y, Yan H, Han X, Zhu Z. The Superiority of Intraoperative O-arm Navigation-assisted Surgery in Instrumenting Extremely Small Thoracic Pedicles of Adolescent Idiopathic Scoliosis: A Case-Control Study. Medicine (Baltimore) 2016; 95:e3581. [PMID: 27149486 PMCID: PMC4863803 DOI: 10.1097/md.0000000000003581] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the accuracy of O-arm navigation-assisted screw insertion in extremely small thoracic pedicles and to compare it with free-hand pedicle screw insertion in adolescent idiopathic scoliosis (AIS).A total of 344 pedicle screws were inserted in apical region (defined as 2 vertebrae above and below the apex each) of 46 AIS patients (age range 13-18 years) with O-arm navigation and 712 screws were inserted in 92 AIS patients (age range 11-17 years) with free-hand technique. According to the narrowest diameter orthogonal to the long axis of the pedicle on a trajectory entering the vertebral body on preoperative computed tomography, the pedicles were classified into large (>3 mm) and small (≤3 mm) subgroups. Furthermore, a subset of extremely small pedicles (≤2 mm in the narrowest diameter) was specifically discussed. Screw accuracy was categorized as grade 0: no perforation, grade 1: perforation by less than 2 mm, grade 2: perforation by 2 to 4 mm, grade 3: perforation over 4 mm.In the O-arm group, the mean thoracic pedicle diameters were 2.23 mm (range 0.7-2.9 mm) and 3.48 mm (3.1-7.1 mm) for small and large pedicles, respectively. In the free-hand group, the small and large thoracic pedicle diameters were 2.42 mm (range 0.6-2.9 mm) and 3.75 mm (3.1-6.9 mm), respectively. The overall accuracies of screw insertion in large and small thoracic pedicles (grade 0, 1) were significantly higher in O-arm group (large: 93.8%, 210/224, small: 91.7%, 110/120) than those of free-hand group (large: 84.9%, 353/416, small: 78.4%, 232/296) (P < 0.05). Importantly, the overall accuracy of screw placement in extremely small pedicles was significantly higher in the O-arm group (84.3%, 48/57) compared with 62.7% (79/126) in free-hand group (P < 0.05), and the incidence of medial perforation was significantly lower in O-arm group (11.1%, 1/9) compared with 17.0% (8/47) in free-hand group (P < 0.05).The O-arm intraoperative navigation system should be acknowledged for its superiority in scoliosis surgery, since it permits more accurate and safer instrumentation for AIS patients with small and extremely small thoracic pedicles.
Collapse
Affiliation(s)
- Zhen Liu
- From the Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | | | | | | | | | | |
Collapse
|
38
|
Lee DJ, Kim SB, Rosenthal P, Panchal RR, Kim KD. Stereotactic guidance for navigated percutaneous sacroiliac joint fusion. J Biomed Res 2015; 30:162-167. [PMID: 28270652 PMCID: PMC4820893 DOI: 10.7555/jbr.30.20150090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/05/2015] [Accepted: 11/20/2015] [Indexed: 11/12/2022] Open
Abstract
Arthrodesis of the sacroiliac joint (SIJ) for surgical treatment of SIJ dysfunction has regained interest among spine specialists. Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement; however, image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement. In the following cases, we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm® multidimensional surgical imaging with StealthStation® navigation (Medtronic, Inc. Minneapolis, MN). Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site. O-arm® integrated with StealthStation® allowed immediate auto-registration. The skin incision was planned with an image-guidance probe. An image-guided awl, drill and tap were utilized to choose a starting point and trajectory. Threaded titanium cage(s) packed with autograft and/or allograft were then placed. O-arm® image-guidance allowed for implant placement in the SIJ with a small skin incision. However, we could not track the cage depth position with our current system, and in one patient, the SIJ cage had to be revised secondary to the anterior breach of sacrum.
Collapse
Affiliation(s)
- Darrin J Lee
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California
| | - Sung-Bum Kim
- Department of Neurological Surgery, Kyung-Hee Medical Center, Seoul, Korea
| | - Philip Rosenthal
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California
| | - Ripul R Panchal
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California
| | - Kee D Kim
- Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California;
| |
Collapse
|
39
|
Jost GF, Walti J, Mariani L, Cattin P. A novel approach to navigated implantation of S-2 alar iliac screws using inertial measurement units. J Neurosurg Spine 2015; 24:447-53. [PMID: 26565762 DOI: 10.3171/2015.6.spine1594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors report on a novel method of intraoperative navigation with inertial measurement units (IMUs) for implantation of S-2 alar iliac (S2AI) screws in sacropelvic fixation of the human spine and its application in cadaveric specimens. METHODS Screw trajectories were planned on a multiplanar reconstruction of the preoperative CT scan. The pedicle finder and screwdriver were equipped with IMUs to guide the axial and sagittal tilt angles of the planned trajectory, and navigation software was developed. The entry points were chosen according to anatomical landmarks on the exposed spine. After referencing, the sagittal and axial orientation of the pedicle finder and screwdriver were wirelessly monitored on a computer screen and aligned with the preoperatively planned tilt angles to implant the S2AI screws. The technique was performed without any intraoperative imaging. Screw positions were analyzed on postoperative CT scans. RESULTS Seventeen of 18 screws showed a good S2AI screw trajectory. Compared with the postoperatively measured tilt angles of the S2AI screws, the IMU readings on the screwdriver were within an axial plane deviation of 0° to 5° in 15 (83%) and 6° to 10° in 2 (11%) of the screws and within a sagittal plane deviation of 0° to 5° in 15 (83%) and 6° to 10° in 3 (17%) of the screws. CONCLUSIONS IMU-based intraoperative navigation may facilitate accurate placement of S2AI screws.
Collapse
Affiliation(s)
| | - Jonas Walti
- Medical Image Analysis Center, University of Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel; and
| | - Philippe Cattin
- Medical Image Analysis Center, University of Basel, Switzerland
| |
Collapse
|
40
|
Mazur MD, Ravindra VM, Schmidt MH, Brodke DS, Lawrence BD, Riva-Cambrin J, Dailey AT. Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine 2015; 23:67-76. [DOI: 10.3171/2014.10.spine14541] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques.
METHODS
The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors.
RESULTS
Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation.
CONCLUSIONS
Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.
Collapse
Affiliation(s)
| | | | | | - Darrel S. Brodke
- 2Orthopaedics, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon D. Lawrence
- 2Orthopaedics, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | | |
Collapse
|
41
|
Guppy KH, Chakrabarti I, Banerjee A. The use of intraoperative navigation for complex upper cervical spine surgery. Neurosurg Focus 2014; 36:E5. [PMID: 24580006 DOI: 10.3171/2014.1.focus13514] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2-3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1-2 with distortion of the anatomy and overgrowth of the bony structure at C-2.
Collapse
Affiliation(s)
- Kern H Guppy
- Department of Neurosurgery, Kaiser Permanente Medical Group, Sacramento, California; and Department of Neurosurgery, University of California, San Francisco, California
| | | | | |
Collapse
|
42
|
Mattei TA, Fassett DR. Letter to the Editor: The O-arm revolution in spine surgery. J Neurosurg Spine 2013; 19:644-7. [DOI: 10.3171/2013.5.spine13474] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|