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Scoville JP, Joyce E, Dailey AT, Mazur MD. A radiological analysis of pelvic fixation trajectories: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23465. [PMID: 37871336 PMCID: PMC10599452 DOI: 10.3171/case23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Three well-defined methods for pelvic fixation are used for biomechanical support in spine fusion constructs: iliac, recessed iliac, and S2-alar-iliac (S2AI) screws. The authors compared the maximum screw sizes that could be placed with these techniques by using image-guidance software and high-resolution computed tomography scans from 20 randomly selected patients. Six trajectories were plotted per side, beginning at recognized starting points (standard or recessed posterior superior iliac spine [PSIS] or S2AI screw) and ending at the anterior inferior iliac spine (AIIS) or supra-acetabular notch (SAN). OBSERVATIONS The mean maximum screw length and width ranged from 80.0 ± 32.2 mm to 140.8 ± 22.6 mm and from 8.25 ± 1.2 mm to 13.0 ± 2.7 mm, respectively, depending on the trajectory. Statistically significant differences in length were found between the standard and recessed PSIS trajectories to the AIIS (p < 0.001) and between the standard PSIS-to-AIIS trajectory and the S2AI-to-AIIS (p = 0.007) or S2AI-to-SAN (p < 0.001) trajectories. The most successful trajectory was the PSIS to SAN (95%, 38/40). LESSONS The traditional iliac screw trajectory enabled the longest and widest screw trajectories and highest rate of successful screw placement with the fewest theoretical breaches more reliably than recessed and S2AI trajectories. These findings may help surgeons plan for maximum screw purchase for pelvic fixation.
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Noureldine MHA, Farooq J, Kumar JI, Pressman E, Coughlin E, Mhaskar R, Alikhani P. Improved Outcomes with Concurrent Instrumentation and Fusion of the Sacroiliac Joint in Patients with Long Lumbosacral Constructs. Global Spine J 2023; 13:2001-2006. [PMID: 35012363 PMCID: PMC10556918 DOI: 10.1177/21925682211069095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Spinal fusion, specifically constructs connected to pelvic bones, has been consistently reported as a predisposing factor to sacroiliac joint (SIJ) pain. The aim of this study is to compare SIJ outcomes in patients with constructs to the pelvis following instrumentation vs instrumentation plus fusion of the SIJ. METHODS Data of study subjects was extracted from a prospectively maintained database as well as retrospectively collected from records at a tertiary academic medical center in the United States between 2018 and 2020. RESULTS A cohort of 103 patients was divided into 2 groups: 65 in Group 1 [S2AI screw without fusion device] and 38 in Group 2 [S2AI screw with fusion device]. None of the patients in Group 2 developed postoperative SIJ pain compared to 44.6% in Group 1. Sacroiliac joint fusion occurred in all Group 2 but none of Group 1 patients. The postoperative Visual Analogue Scale (VAS) for lower extremity (LE) pain (.8 vs .5; P = .03) and postoperative Oswestry Disability Index (ODI) (18.7 vs 14.2; P < .01) were significantly higher in Group 1. The rate of distal junctional break, failure, and/or kyphosis (DJBFK) and time to DJBFK were not significantly different between the two groups, and the rate of DJBFK did not change in the presence of multiple covariates. CONCLUSION The SIJs carry the heavy load of long lumbosacral fusion constructs extending to the pelvis. Simultaneous SIJ instrumentation and fusion decreases the risk of disability, prevents the development of postoperative SIJ pain, and may also protect the S2AI screw from loosening and failure.
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Affiliation(s)
- Mohammad Hassan A. Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jeffrey Farooq
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jay I. Kumar
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Emily Coughlin
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Puya Alikhani
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Pan A, Yang H, Hai Y, Liu Y, Zhang X, Ding H, Li Y, Lu H, Ding Z, Xu Y, Pei B. Adding sacral anchors through an S1 alar screw and multirod construct as a strategy for lumbosacral junction augmentation: an in vitro comparison to S1 pedicle screws alone with sacroiliac fixation. J Neurosurg Spine 2023; 38:107-114. [PMID: 36029265 DOI: 10.3171/2022.6.spine22424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Achieving solid fusion of the lumbosacral junction continues to be a challenge in long-segment instrumentation to the sacrum. The purpose of this study was to test the condition of adding sacral anchors through an S1 alar screw (S1AS) and multirod construct relative to using S1 pedicle screws (S1PSs) alone with sacroiliac fixation in lumbosacral junction augmentation. METHODS Seven fresh-frozen human lumbar-pelvic spine cadaveric specimens were tested under nondestructive moments (7.5 Nm). The ranges of motion (ROMs) in extension, flexion, left and right lateral bending (LB), and axial rotation (AR) of instrumented segments (L3-S1); the lumbosacral region (L5-S1); and the adjacent segment (L2-3) were measured, and the axial construct stiffness (ACS) was recorded. The testing conditions were 1) intact; 2) bilateral pedicle screw (BPS) fixation at L3-S1 (S1PS alone); 3) BPS and unilateral S2 alar iliac screw (U-S2AIS) fixation; 4) BPS and unilateral S1AS (U-S1AS) fixation; 5) BPS and bilateral S2AIS (B-S2AIS) fixation; and 6) BPS and bilateral S1AS (B-S1AS) fixation. Accessory rods were used in testing conditions 3-6. RESULTS In all directions, the ROMs of L5-S1 and L3-S1 were significantly reduced in B-S1AS and B-S2AIS conditions, compared with intact and S1PS alone. There was no significant difference in reduction of the ROMs of L5-S1 between B-S1ASs and B-S2AISs. Greater decreased ROMs of L3-S1 in extension and AR were detected with B-S2AISs than with B-S1ASs. Both B-S1ASs and B-S2AISs significantly increased the ACS compared with S1PSs alone. The ACS of B-S2AISs was significantly greater than that of B-S1ASs, but with greater increased ROMs of L2-3 in extension. CONCLUSIONS Adding sacral anchors through S1ASs and a multirod construct was as effective as sacropelvic fixation in lumbosacral junction augmentation. The ACS was less than the sacropelvic fixation but with lower ROMs of the adjacent segment. The biomechanical effects of using S1ASs in the control of long-instrumented segments were moderate (better than S1PSs alone but worse than sacropelvic fixation). This strategy is appropriate for patients requiring advanced lumbosacral fixation, and the risk of sacroiliac joint violation can be avoided.
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Affiliation(s)
- Aixing Pan
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Honghao Yang
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Yong Hai
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Yuzeng Liu
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Xinuo Zhang
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Hongtao Ding
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Yue Li
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Hongyi Lu
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Zihao Ding
- 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University
| | - Yangyang Xu
- 2Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Baoqing Pei
- 2Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery. Spine (Phila Pa 1976) 2022; 47:986-994. [PMID: 35819333 DOI: 10.1097/brs.0000000000004356] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/05/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort review of a prospective multicenter database. OBJECTIVE Identify rates and variations in lumbopelvic fixation failure after adult spinal deformity (ASD) correction. SUMMARY OF BACKGROUND DATA Traditional iliac (IS) and S2-alar-iliac (S2AI) pelvic fixation methods have unique technical characteristics for their application, and result in varied bio-mechanical and anatomic impact. These differences may lead to variance in lumbopelvic fixation failure types/rates. METHODS ASD patients undergoing correction with more than five level fusion and pelvic fixation, separated by pelvic fixation type (IS vs. S2AI). Fixation fracture or loosening assessed radiographically (Figure 1). Multivariate logistic regression, accounting for significant confounders, was used to examine differences between the two groups for screw loosening/fracture, rod fracture, and revision surgery. Level of significance set at P< 0.05. RESULTS Four hundred eighteen of 1422 patients were included (IS = 287, S2AI = 131). The groups had similar age, body mass index (BMI), baseline comorbidities, number of levels fused (P>0.05), baseline health related quality of life measures (HRQLs) (short form survey-36, Oswestry Disability Index [ODI], Scoliosis Research Society [SRS-22], numeric rating scale [NRS] leg and back, P>0.05) and deformity (pelvic tilt [PT], pelvic incidence-lumbar lordosis [PI-LL], and sagittal vertical axis [SVA], P> 0.05). The IS group had more unilateral fixation versus S2AI (12.9% vs. 6%; P = 0.02). The overall lumbopelvic fixation failure rate was 23.74%. Pelvic fixation (13.4%) and S1 screw (2.9%) loosening was more likely with S2AI (odds ratio [OR] 2.63, P = 0.001; OR 6.05, P = 0.022). Pelvic screw (2.3%) and rod fracture (14.1%) rates similar between groups but trended toward less occurrence with S2AI (OR 0.47, P= 0.06). Revision surgery occurred in 22.7%, and in 8.5% for iliac fixation specifically, but with no differences between fixation types (P = 0.55 and P = 0.365). Pelvic fixation failure conferred worse HRQL scores (physical component score [PCS] 36.23 vs. 39.37, P= 0.04; ODI 33.81 vs. 27.93, P = 0.036), and less 2 years improvement (PCS 7.69 vs. 10.46, P = 0.028; SRS 0.83 vs. 1.03, P = 0.019; ODI 12.91 vs. 19.77, P = 0.0016). CONCLUSION Lumbopelvic fixation failure rates were high following ASD correction, and associated with lesser clinical improvements. S2AI screws were more likely to demonstrate loosening, but less commonly associated with rod fractures at the lumbopelvic region.
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Tabarestani TQ, Sykes D, Murphy KR, Wang TY, Shaffrey CI, Goodwin CR, Horne P, Than KD, Abd-El-Barr MM. Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience. Front Surg 2022; 9:889906. [PMID: 35784931 PMCID: PMC9243459 DOI: 10.3389/fsurg.2022.889906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Interest in robotic-assisted spine surgery has grown as surgeon comfort and technology has evolved to maximize benefits of time saving and precision. However, the Food and Drug Administration (FDA) has currently only approved robotics to assist in determining the ideal trajectory for pedicle screw placement after extensive research supporting its efficacy and efficiency. To be considered a durable and effective option, robotics need to expand beyond the indication of just placing pedicle screws. This article aims to illustrate a multi-surgeon, single-institution experience with unique applications of robotic technologies in spine surgery. We will explore accessing Kambin's Triangle in percutaneous transforaminal interbody fusion (percLIF), iliac fixation in metastatic cancer, and sacroiliac (SI) fusions. Each of these topics will be covered in depth with associated background information and subsequent discussion. We show that with proper understanding of its limitations, robots can help surgeons perform difficult surgeries in a safe manner.
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Affiliation(s)
- Troy Q Tabarestani
- Duke University School of Medicine, Duke University Hospital, Durham, Durham, NC
| | - David Sykes
- Duke University School of Medicine, Duke University Hospital, Durham, Durham, NC
| | - Kelly R Murphy
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
| | | | - C Rory Goodwin
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
| | - Phillip Horne
- Department of Orthopedic Surgery, Duke University Hospital, Durham, Durham, NC
| | - Khoi D Than
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
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Panico M, Bassani T, Villa TMT, Galbusera F. The Simulation of Muscles Forces Increases the Stresses in Lumbar Fixation Implants with Respect to Pure Moment Loading. Front Bioeng Biotechnol 2021; 9:745703. [PMID: 34881230 PMCID: PMC8645959 DOI: 10.3389/fbioe.2021.745703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Simplified loading conditions such as pure moments are frequently used to compare different instrumentation techniques to treat spine disorders. The purpose of this study was to determine if the use of realistic loading conditions such as muscle forces can alter the stresses in the implants with respect to pure moment loading. A musculoskeletal model and a finite element model sharing the same anatomy were built and validated against in vitro data, and coupled in order to drive the finite element model with muscle forces calculated by the musculoskeletal one for a prescribed motion. Intact conditions as well as a L1-L5 posterior fixation with pedicle screws and rods were simulated in flexion-extension and lateral bending. The hardware stresses calculated with the finite element model with instrumentation under simplified and realistic loading conditions were compared. The ROM under simplified loading conditions showed good agreement with in vitro data. As expected, the ROMs between the two types of loading conditions showed relatively small differences. Realistic loading conditions increased the stresses in the pedicle screws and in the posterior rods with respect to simplified loading conditions; an increase of hardware stresses up to 40 MPa in extension for the posterior rods and 57 MPa in flexion for the pedicle screws were observed with respect to simplified loading conditions. This conclusion can be critical for the literature since it means that previous models which used pure moments may have underestimated the stresses in the implants in flexion-extension and in lateral bending.
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Affiliation(s)
- Matteo Panico
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tomaso Maria Tobia Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Robotic-assisted percutaneous iliac screw fixation for destructive lumbosacral metastatic lesions: an early single-institution experience. Acta Neurochir (Wien) 2021; 163:2983-2990. [PMID: 34129101 DOI: 10.1007/s00701-021-04894-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Robotic-assisted surgery is becoming more widely applied in surgical subspecialties due to its intraoperative and postoperative advantages such as minimally invasive approach, reduced blood loss, shorter hospital stay, and decreased incidence of postoperative complications. However, robotic devices were only recently introduced in the field of spinal surgery. Specifically, percutaneous approaches involving computer-assisted image guidance are relatively new in iliac screw fixation. Previous methods focused on the use of S2-alar-iliac (S2AI) screw fixation which allows for pelvic fixation without a need for side connectors. However, for patients with destructive lesions of the sacrum, placement of these S2AI screws may not be feasible. The purpose of this technical note is to illustrate the implementation of robotic-assisted percutaneous iliac screw fixation in two cases which allows for minimally invasive attachment to the proximal lumbar screws without a side connector and eliminates a potential source of instrumentation failure. METHODS Robotic-assisted percutaneous iliac screw fixation was performed on two patients. The robotics system was used to merge the fluoroscopic images with intraoperative computed tomography (CT) images to plan the trajectories for placement of bilateral pedicle and iliac screws. Intraoperative CT scan was again performed to confirm proper placement of all screws. Rods were then engaged bilaterally with the pedicle and iliac screws without the use of side connectors. RESULTS The patients did not experience immediate postoperative complications and had stable hardware at one-month follow-up. Our cases demonstrate the surgical efficiency of robotic-assisted lumbo-iliac instrumentation which obviates the need to use a side connector, which is commonly used in iliac fixation. This eliminates a step, which can reduce the possibility of instrumentation failure. CONCLUSION Robotic-assisted percutaneous iliac screw fixation is a safe and feasible technique to improve operative and clinical outcomes in complex spinal instrumentation surgeries.
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Panico M, Chande RD, Lindsey DP, Mesiwala A, Villa TMT, Yerby SA, Gallazzi E, Brayda-Bruno M, Galbusera F. Innovative sacropelvic fixation using iliac screws and triangular titanium implants. 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 2021; 30:3763-3770. [PMID: 34562177 DOI: 10.1007/s00586-021-07006-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/19/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for the correction of severe spinal deformities. The purpose of this study was to explore the effects of the triangular titanium implants on the iliac screw fixation. Our hypothesis was that the use of triangular titanium implants can increase the stability of the iliac screw fixation. METHODS Three T10-pelvis instrumented models were created: pedicle screws and rods in T10-S1, and bilateral iliac screws (IL); posterior fixation and bilateral iliac screws and triangular implants inserted bilaterally in a sacro-alar-iliac trajectory (IL-Tri-SAI); posterior fixation and bilateral iliac screws and two bilateral triangular titanium implants inserted in a lateral trajectory (IL-Tri-Lat). Outputs of these models, such as hardware stresses, were compared against a model with pedicle screws and rods in T10-S1 (PED). RESULTS Sacropelvic fixation decreased the L5-S1 motion by 75-90%. The motion of the SIJ was reduced by 55-80% after iliac fixation; the addition of triangular titanium implants further reduced it. IL, IL-Tri-SAI and IL-Tri-Lat demonstrated lower S1 pedicle stresses with respect to PED. Triangular implants had a protective effect on the iliac screw stresses. CONCLUSION Sacropelvic fixation decreased L5-S1 range of motion suggesting increased stability of the joint. The combination of triangular titanium implants and iliac screws reduced the residual flexibility of the sacroiliac joint, and resulted in a protective effect on the S1 pedicle screws and iliac screws themselves. Clinical studies may be performed to demonstrate applicability of these FEA results to patient outcomes.
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Affiliation(s)
- Matteo Panico
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, 20133, Milan, Italy. .,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | | | | | - Ali Mesiwala
- Southern California Center for Neuroscience and Spine, Pomona, CA, USA
| | - Tomaso Maria Tobia Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, 20133, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Enrico Gallazzi
- ASST Gaetano Pini: Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
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de Andrada Pereira B, Wangsawatwong P, Lehrman JN, Sawa AGU, Lindsey DP, Yerby SA, Godzik J, Waguespack AM, Uribe JS, Kelly BP. Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution. J Neurosurg Spine 2021; 36:42-52. [PMID: 34534964 DOI: 10.3171/2021.3.spine202175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE S2 alar-iliac (S2AI) screw fixation effectively enhances stability in long-segment constructs. Although S2AI fixation provides a single transarticular sacroiliac joint fixation (SIJF) point, additional fixation points may provide greater stability and attenuate screw and rod strain. The objectives of this study were to evaluate changes in stability and pedicle screw and rod strain with extended distal S2AI fixation and with supplemental bilateral integration of two sacroiliac joint fusion devices implanted using a traditional minimally invasive surgical approach. METHODS Eight L1-pelvis human cadaveric specimens underwent pure moment (7.5 Nm) and compression (400 N) tests under 4 conditions: 1) intact (pure moment loading only); 2) L2-S1 pedicle screw and rod with L5-S1 interbody fusion; 3) added S2AI screws; and 4) added bilateral laterally placed SIJF. Range of motion (ROM), rod strain, and screw-bending moment (S1 and S2AI) were analyzed. RESULTS Compared with S1 fixation, S2AI fixation significantly reduced L5-S1 ROM in right lateral bending by 50% (0.11°, p = 0.049) and in compression by 39% (0.22°, p = 0.003). Compared with fixation ending at S1, extending fixation with S2AI significantly decreased sacroiliac joint ROM by 52% (0.28°, p = 0.02) in flexion, by 65% (0.48°, p = 0.04) in extension, by 59% (0.76°, p = 0.02) in combined flexion-extension, and by 36% (0.09°, p = 0.02) in left axial rotation. The addition of S2AI screws reduced S1 screw-bending moment during flexion (0.106 Nm [43%], p = 0.046). With S2AI fixation, posterior L5-S1 primary rod strain increased by 124% (159 μE, p = 0.002) in flexion, by 149% (285 μE, p = 0.02) in left axial rotation, and by 99% (254 μE, p = 0.04) in right axial rotation. Compared with S2AI fixation, the addition of SIJF reduced L5-S1 strain during right axial rotation by 6% (28 μE, p = 0.04) and increased L5-S1 strain in extension by 6% (28 μE, p = 0.02). CONCLUSIONS Long-segment constructs ending with S2AI screws created a more stable construct than those ending with S1 screws, reducing lumbosacral and sacroiliac joint motion and S1 screw-bending moment in flexion. These benefits, however, were paired with increased rod strain at the lumbosacral junction. The addition of SIJF to constructs ending at S2AI did not significantly change SI joint ROM or S1 screw bending and reduced S2AI screw bending in compression. SIJF further decreased L5-S1 rod strain in axial rotation and increased it in extension.
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Affiliation(s)
- Bernardo de Andrada Pereira
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Piyanat Wangsawatwong
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jennifer N Lehrman
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Anna G U Sawa
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | - Jakub Godzik
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | - Juan S Uribe
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Brian P Kelly
- 1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Li B, Chan AK, Mummaneni PV, Burke JF, Safaee MM, Chou D. Preliminary experience using S1-alar iliac fixation with navigation: technical note. J Neurosurg Spine 2021; 35:774-779. [PMID: 34450588 DOI: 10.3171/2021.1.spine201744] [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: 09/26/2020] [Accepted: 01/25/2021] [Indexed: 11/06/2022]
Abstract
Traditional iliac screws and S2-alar iliac (S2-AI) screws are common methods used for pelvic fixation, and many surgeons advocate pelvic fixation for long-segment fixation to the sacrum. However, in patients without severe deformities and only degenerative conditions, many surgeons may choose S1 screws only. Moreover, even with S2-AI screws, there is more muscular dissection than with using S1 screws, and the rod connection can be cumbersome in both S2-AI fixation and placing iliac screws. Using a surgical video, artist's illustration, and intraoperative photographs, the authors describe the S1-AI screw fixation technique that allows for single-screw sacral and iliac fixation, requires less distal dissection of the sacrum, allows for easier rod connection, and may be an option in degenerative conditions needing pelvic fixation. However, this is a preliminary feasibility study, and in long fusion constructs, this type of fixation has only been used in conjunction with L5-S1 anterior lumbar interbody fusion (ALIF), and there are no long-term data on the use of this screw fixation technique without ALIF. In short-segment revision fusions, this technique may be considered for salvage in cases of large halos in the sacrum from loosened S1 screw fixation.
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Affiliation(s)
- Bo Li
- 1Department of Neurosurgery, University of California, San Francisco, California; and.,2Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Andrew K Chan
- 1Department of Neurosurgery, University of California, San Francisco, California; and
| | - Praveen V Mummaneni
- 1Department of Neurosurgery, University of California, San Francisco, California; and
| | - John F Burke
- 1Department of Neurosurgery, University of California, San Francisco, California; and
| | - Michael M Safaee
- 1Department of Neurosurgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurosurgery, University of California, San Francisco, California; and
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11
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The Effect of Sacroiliac Fusion and Pelvic Fixation on Rod Strain in Thoracolumbar Fusion Constructs: A Biomechanical Investigation. Spine (Phila Pa 1976) 2021; 46:E769-E775. [PMID: 34160368 DOI: 10.1097/brs.0000000000003911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro biomechanical study. OBJECTIVE Investigate effects of sacroiliac joint (SIJ) fusion and iliac fixation on distal rod strain in thoracolumbar fusions. SUMMARY OF BACKGROUND DATA Instrument failure is a multifactorial, challenging problem frequently encountered by spinal surgeons. Increased rod strain may lead to instrumentation failure and rod fracture. METHODS Seven fresh frozen human cadaveric specimens (T9-pelvis) used. Six operative constructs tested to investigate changes in rod strain at L5-S1 and S1-Ilium rods, posterior pedicle screws/rods from T10-S1 (PS), PS + bilateral iliac screw fixation, PS + unilateral iliac screw fixation (UIS), PS+UIS+3 unilateral SIJ screws, PS + 3 unilateral SIJ screws, and PS +6 bilateral SIJ screws. Uniaxial strain gauges were used to measure surface strain of rods during flexion-extension. RESULTS In flexion-extension, bilateral iliac screws added significant strain to L5-S1 compared with long fusion constructs ending at S1 (PS) (P < 0.05). Unilateral iliac fixation exhibited highest strain to L5-S1 ipsilateral rod, was significantly higher compared with bilateral iliac fixation and PS construct. Unilateral and bilateral SIJ fusion did not significantly change L5-S1 rod strain compared with PS. When measuring S1-Ilium rod strain, unilateral pelvic fixation had highest reported rod strain, approached significance compared with bilateral iliac screws (P = 0.054). Addition of contralateral SIJ fusion did not affect rod strain at S1-ilium on side with unilateral fixation. CONCLUSION Results showed additional fixation below S1 to pelvis added significant rod strain. Unilateral pelvic screws had highest rod strain; SIJ fusion did not affect rod strain. Findings can help guide surgeons when associated risk of rod failure is a consideration.Level of Evidence: N/A.
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de Andrada Pereira B, Lehrman JN, Sawa AGU, Lindsey DP, Yerby SA, Godzik J, Waguespack AM, Uribe JS, Kelly BP. Biomechanical effects of a novel posteriorly placed sacroiliac joint fusion device integrated with traditional lumbopelvic long-construct instrumentation. J Neurosurg Spine 2021:1-10. [PMID: 34144523 DOI: 10.3171/2020.11.spine201540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE S2-alar-iliac (S2AI) screw fixation effectively ensures stability and enhances fusion in long-segment constructs. Nevertheless, pelvic fixation is associated with a high rate of mechanical failure. Because of the transarticular nature of the S2AI screw, adding a second point of fixation may provide additional stability and attenuate strains. The objective of the study was to evaluate changes in stability and strain with the integration of a sacroiliac (SI) joint fusion device, implanted through a novel posterior SI approach, supplemental to posterior long-segment fusion. METHODS L1-pelvis human cadaveric specimens underwent pure moment (7.5 Nm) and compression (400 N) tests in the following conditions: 1) intact, 2) L2-S1 pedicle screw and rod fixation with L5-S1 interbody fusion, 3) added S2AI screws, and 4) added bilateral SI joint fixation (SIJF). The range of motion (ROM), rod strain, and screw bending moments (S1 and S2AI) were analyzed. RESULTS S2AI fixation decreased L2-S1 ROM in flexion-extension (p ≤ 0.04), L5-S1 ROM in flexion-extension and compression (p ≤ 0.004), and SI joint ROM during flexion-extension and lateral bending (p ≤ 0.03) compared with S1 fixation. SI joint ROM was significantly less with SIJF in place than with the intact joint, S1, and S2AI fixation in flexion-extension and lateral bending (p ≤ 0.01). The S1 screw bending moment decreased following S2AI fixation by as much as 78% in extension, but with statistical significance only in right axial rotation (p = 0.03). Extending fixation to S2AI significantly increased the rod strain at L5-S1 during flexion, axial rotation, and compression (p ≤ 0.048). SIJF was associated with a slight increase in rod strain versus S2AI fixation alone at L5-S1 during left lateral bending (p = 0.048). Compared with the S1 condition, fixation to S2AI increased the mean rod strain at L5-S1 during compression (p = 0.048). The rod strain at L5-S1 was not statistically different with SIJF compared with S2AI fixation (p ≥ 0.12). CONCLUSIONS Constructs ending with an S2AI screw versus an S1 screw tended to be more stable, with reduced SI joint motion. S2AI fixation decreased the S1 screw bending moments compared with fixation ending at S1. These benefits were paired with increased rod strain at L5-S1. Supplementation of S2AI fixation with SIJF implants provided further reductions (approximately 30%) in the sagittal plane and lateral bending SI joint motion compared with fixation ending at the S2AI position. This stability was not paired with significant changes in rod or screw strains.
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Affiliation(s)
| | | | - Anna G U Sawa
- 1Department of Neurosurgery, Spinal Biomechanics Laboratory, and
| | | | | | - Jakub Godzik
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Juan S Uribe
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brian P Kelly
- 1Department of Neurosurgery, Spinal Biomechanics Laboratory, and
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Cui L, Gong S, Xie S, Zhang L, Peng W. Efficacy of three-dimensional guide plate technique guided sacral 2 alar iliac screws fixation in patients with degenerative kyphoscoliosis. Am J Transl Res 2021; 13:5127-5136. [PMID: 34150101 PMCID: PMC8205660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the efficacy of three-dimensional (3D) guide plate technique guided sacral 2 alar iliac (S2AI) screws fixation in patients with degenerative kyphoscoliosis. METHODS Eighty-four patients with degenerative kyphoscoliosis who were admitted to our hospital were selected as the subjects. They were divided into control group and observation group by the random number table method, with 42 patients in each group. S2AI free-hand screw implantation technique was adopted for screws fixation in control group; 3D guide plate technique guided S2AI screw implantation was used for screws fixation in observation group. A 2-year routine follow-up was carried out after the surgery. The followings were compared: screw parameters of preoperative pre-set screw trajectory and postoperative actual screw trajectory: sagittal angle (SA), transverse angle (TA), horizon distance from the entry point to the median sacral crest (HD), vertical distance from the entry point to the superior margin of the second posterior sacral foramina (VD), and the incidence rate of complications; scoliosis Cobb angle, sagittal vertical axis, C7 plumb line-center sacral vertical line (C7PL-CSVL), regional kyphosis Cobb angle (RK), pelvic incidence (PI), and pelvic tilt (PT) before, after and 2 years after surgery; Oswestry disability index (ODI) and shot form 36 health survey questionnaire (SF-36) before and 2 years after surgery. RESULTS The difference between preoperative simulation and postoperative actual values of SA, TA, HD and VD was significantly lower in observation group than in control group (P<0.001). Scoliosis Cobb angle, lumbar lordosis, C7PL-CSVL, RK, PI and PT after and 2 years after surgery were significantly improved than those before surgery in the two groups (P<0.001), and there was no significant difference between those after surgery and 2 years after surgery (P>0.05). Patients in the two groups had significantly lower ODI scores and higher SF-36 scores at 2 years after surgery than those before surgery (both P<0.001), and there was no significant difference at 2 years after surgery between the two groups (P>0.05). The incidence rate of complications in observation group was significantly smaller than that in control group (P<0.05). CONCLUSION 3D guide plate technique guided S2AI fixation can significantly increase the accuracy of screw implantation, effectively correct degenerative kyphoscoliosis, achieve rigid internal fixation, improve patient's spinal function and quality of life, and greatly enhance surgical safety, which is worthy of clinical popularization.
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Affiliation(s)
- Liqiang Cui
- Department of Spinal Surgery, Mianyang Orthopaedic HospitalMianyang, Sichuan Province, China
| | - Shuangquan Gong
- Department of Spinal Surgery, Mianyang Orthopaedic HospitalMianyang, Sichuan Province, China
| | - Shiming Xie
- Department of Orthopaedics, Mianyang Tumor HospitalMianyang, Sichuan Province, China
| | - Lei Zhang
- Department of Spinal Surgery, Mianyang Orthopaedic HospitalMianyang, Sichuan Province, China
| | - Wusi Peng
- Department of Spinal Surgery, Mianyang Orthopaedic HospitalMianyang, Sichuan Province, China
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Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
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Panico M, Chande RD, Lindsey DP, Mesiwala A, Villa TMT, Yerby SA, Brayda-Bruno M, Galbusera F. The use of triangular implants to enhance sacropelvic fixation: a finite element investigation. Spine J 2020; 20:1717-1724. [PMID: 32502655 DOI: 10.1016/j.spinee.2020.05.552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Long thoracolumbar fixation and fusion have become a consolidated treatment for severe spinal disorders. Concomitant sacropelvic fixation with S2 alar-iliac (S2AI) screws is frequently performed to limit instrumentation failure and pseudarthrosis at the lumbosacral junction. PURPOSE This study explored the use of triangular titanium implants in different configurations in which the implants supplemented standard sacropelvic fixation with S2AI screws in order to further increase the stability of S2AI fixation. STUDY DESIGN Finite element study. METHODS Four T10-pelvis instrumented models were built: pedicle screws and rods in T10-S1 (PED); pedicle screws and rods in T10-S1, and bilateral S2 alar-iliac screws (S2AI); pedicle screws and rods in T10-S1, bilateral S2AI screws, and triangular implants inserted bilaterally in a sacral alar-iliac trajectory (Tri-SAI); pedicle screws and rods in T10-S1, bilateral S2AI screws and two bilateral triangular titanium implants inserted in a lateral trajectory (Tri-Lat). The models were tested under pure moments of 7.5 Nm in flexion-extension, lateral bending and axial rotation. RESULTS SIJ motion was reduced by 50% to 66% after S2AI fixation; the addition of triangular titanium implants in either a SAI or a lateral trajectory further reduced it. S2AI, Tri-SAI, and Tri-Lat resulted in significantly lower stresses in S1 pedicle screws when compared to PED. Triangular implants had a protective effect on the maximal stresses in S2AI screws, especially when placed in the SAI trajectory. Sacropelvic fixation did not have any protective effect on the posterior rods. CONCLUSIONS Supplementing S2AI screws with triangular implants had a protective effect on the S2AI screws themselves, as well as the S1 pedicle screws, in the tested model. CLINICAL SIGNIFICANCE Triangular implants can substantially reduce the residual flexibility of the SIJ with respect to S2AI fixation alone, suggesting a possible role in patients needing reinforced fixation. In vivo investigation is needed to determine if these in vitro effects translate into clinically important differences.
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Affiliation(s)
- Matteo Panico
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | | | - Ali Mesiwala
- Southern California Center for Neuroscience and Spine, Pomona, CA, USA
| | - Tomaso Maria Tobia Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
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Iijima Y, Kotani T, Sakuma T, Nakayama K, Akazawa T, Kishida S, Muramatsu Y, Sasaki Y, Ueno K, Asada T, Sato K, Minami S, Ohtori S. Risk Factors for Loosening of S2 Alar Iliac Screw: Surgical Outcomes of Adult Spinal Deformity. Asian Spine J 2020; 14:864-871. [PMID: 32718132 PMCID: PMC7788364 DOI: 10.31616/asj.2020.0100] [Citation(s) in RCA: 5] [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: 03/10/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose To determine the risk factors for S2 alar iliac (S2AI) screw loosening and its association with lumbosacral fusion in patients with adult spinal deformity (ASD). Overview of Literature S2AI screws have been widely used for ASD surgery in recent years. However, no studies have analyzed the risk factors for loosening of S2AI screws and its association with lumbosacral fusion. Methods Cases of 50 patients with ASD who underwent long spinal fusion (>9 levels) with S2AI screws were retrospectively reviewed. Loosening of S2AI screws and S1 pedicle screws and bone fusion at the level of L5–S1 at 2 years after surgery were investigated using computed tomography. In addition, risk factors for loosening of S2AI screws were determined in patients with ASD. Results At 2 years after surgery, 33 cases (66%) of S2AI screw loosening and six cases (12%) of S1 pedicle screw loosening were observed. In 40 of 47 cases (85%), bone fusion at L5–S1 was found. Pseudarthrosis at L5–S1 was not significantly associated with S2AI screw loosening (19.3% vs. 6.3%, p=0.23), but significantly higher in patients with S1 screw loosening (83.3% vs. 4.9%, p<0.001). On multivariate logistic regression analyses, high upper instrumented vertebra (UIV) level (T5 or above) (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.0–18.6; p=0.045) and obesity (OR, 11.4; 95% CI, 1.2–107.2; p=0.033) were independent risk factors for S2AI screw loosening. Conclusions High UIV level (T5 or above) and obesity were independent risk factors for S2AI screw loosening in patients with lumbosacral fixation in surgery for ASD. The incidence of lumbosacral fusion is associated with S1 screw loosening, but not S2AI screw loosening.
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Affiliation(s)
- Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Keita Nakayama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shunji Kishida
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yuta Muramatsu
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yu Sasaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Keisuke Ueno
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tomoyuki Asada
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Kosuke Sato
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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de Ruiter GCW, Arts MP, Oosterhuis JWA, Marinelli A, Peul WC. Letter to the Editor. Giant presacral schwannomas. J Neurosurg Spine 2020; 33:421-422. [PMID: 32413864 DOI: 10.3171/2020.4.spine20311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sun MK, Passaro AP, Latchoumane CF, Spellicy SE, Bowler M, Goeden M, Martin WJ, Holmes PV, Stice SL, Karumbaiah L. Extracellular Vesicles Mediate Neuroprotection and Functional Recovery after Traumatic Brain Injury. J Neurotrauma 2020; 37:1358-1369. [PMID: 31774030 DOI: 10.1089/neu.2019.6443] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The lack of effective therapies for moderate-to-severe traumatic brain injuries (TBIs) leaves patients with lifelong disabilities. Neural stem cells (NSCs) have demonstrated great promise for neural repair and regeneration. However, direct evidence to support their use as a cell replacement therapy for neural injuries is currently lacking. We hypothesized that NSC-derived extracellular vesicles (NSC EVs) mediate repair indirectly after TBI by enhancing neuroprotection and therapeutic efficacy of endogenous NSCs. We evaluated the short-term effects of acute intravenous injections of NSC EVs immediately following a rat TBI. Male NSC EV-treated rats demonstrated significantly reduced lesion sizes, enhanced presence of endogenous NSCs, and attenuated motor function impairments 4 weeks post-TBI, when compared with vehicle- and TBI-only male controls. Although statistically not significant, we observed a therapeutic effect of NSC EVs on brain lesion volume, nestin expression, and behavioral recovery in female subjects. Our study demonstrates the neuroprotective and functional benefits of NSC EVs for treating TBI and points to gender-dependent effects on treatment outcomes, which requires further investigation.
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Affiliation(s)
- Min Kyoung Sun
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
- Interdisciplinary Neuroscience Program, University of Georgia, Athens, Georgia, USA
| | - Austin P Passaro
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
- Interdisciplinary Neuroscience Program, University of Georgia, Athens, Georgia, USA
| | - Charles-Francois Latchoumane
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, Georgia, USA
| | - Samantha E Spellicy
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
- Interdisciplinary Neuroscience Program, University of Georgia, Athens, Georgia, USA
| | - Michael Bowler
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, USA
| | - Morgan Goeden
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, USA
| | - William J Martin
- Animal Health Research Center, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Philip V Holmes
- Interdisciplinary Neuroscience Program, University of Georgia, Athens, Georgia, USA
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Steven L Stice
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
- Interdisciplinary Neuroscience Program, University of Georgia, Athens, Georgia, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, Georgia, USA
| | - Lohitash Karumbaiah
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
- Interdisciplinary Neuroscience Program, University of Georgia, Athens, Georgia, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, Georgia, USA
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Casaroli G, Bassani T, Brayda-Bruno M, Luca A, Galbusera F. What do we know about the biomechanics of the sacroiliac joint and of sacropelvic fixation? A literature review. Med Eng Phys 2019; 76:1-12. [PMID: 31866118 DOI: 10.1016/j.medengphy.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this review is to summarize the general knowledge about the biomechanics of the sacroiliac joint and sacropelvic fixation techniques. Additionally, this study aims to support biomechanical investigations in defining experimental protocols as well as numerical modeling of the sacropelvic structures. The sacroiliac joint is characterized by a large variability of shape and ranges of motion among individuals. Although the ligament network and the anatomical features strongly limit the joint movements, sacroiliac displacements and rotations are not negligible. Currently available treatments for sacroiliac joint dysfunction include physical therapy, steroid injections, Radio-frequency ablation of specific neural structures, and open or minimally invasive SIJ fusion. In long posterior construct, the most common solutions are the iliac screws and the S2 alar - iliac screws, whereas for the joint fixation alone, mini - invasive alternative system can be used. Several studies reported the clinical outcomes of the different techniques and investigated the biomechanical stability of the relative construct, but the effect of sacropelvic fixation techniques on the joint flexibility and on the stress generated into the bone is still unknown. In our opinion, more biomechanical analyses on the behavior of the sacroiliac joint may be performed in order to better predict the risk of failure or instability of the joint.
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Affiliation(s)
- Gloria Casaroli
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Marco Brayda-Bruno
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Andrea Luca
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Galbusera
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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Galbusera F, Casaroli G, Chande R, Lindsey D, Villa T, Yerby S, Mesiwala A, Panico M, Gallazzi E, Brayda-Bruno M. Biomechanics of sacropelvic fixation: a comprehensive finite element comparison of three techniques. 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 2019; 29:295-305. [PMID: 31773275 DOI: 10.1007/s00586-019-06225-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/09/2019] [Accepted: 11/16/2019] [Indexed: 02/26/2023]
Abstract
PURPOSE Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for complex deformity correction and is commonly associated with pseudoarthrosis, implant failure and loosening. This study compared pedicle screw fixation (PED) with three different sacropelvic fixation techniques, namely iliac screws (IL), S2 alar-iliac screws (S2AI) and laterally placed triangular titanium implants (SI), all in combination with lumbosacral instrumentation, accounting for implant micromotion. METHODS Existing finite element models of pelvis-L5 of three patients including lumbopelvic instrumentation were utilized. Moments of 7.5 Nm in the three directions combined with a 500 N compressive load were simulated. Measured metrics included flexibility, instrumentation stresses and bone-implant interface loads. RESULTS Fixation effectively reduced the sacroiliac flexibility. Compared to PED, IL and S2AI induced a reduction in peak stresses in the S1 pedicle screws. Rod stresses were mostly unaffected by S2AI and SI, but IL demonstrated a stress increase. In comparison with a previous work depicting full osteointegration, SI was found to have similar instrumentation stresses as those due to PED. CONCLUSIONS Fixation with triangular implants did not result in stress increase on the lumbosacral instrumentation, likely due to the lack of connection with the posterior rods. IL and S2AI had a mild protective effect on S1 pedicle screws in terms of stresses and bone-implant loads. IL resulted in an increase in the rod stresses. A comparison between this study and previous work incorporating full osteointegration demonstrates how these results may be applied clinically to better understand the effects of different treatments on patient outcomes. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy.
| | - Gloria Casaroli
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy
| | | | | | - Tomaso Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico Di Milano, Milan, Italy
| | | | - Ali Mesiwala
- Southern California Center for Neuroscience and Spine, Pomona, CA, USA
| | - Matteo Panico
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy.,Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico Di Milano, Milan, Italy
| | - Enrico Gallazzi
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy
| | - Marco Brayda-Bruno
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy
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Supplemental rods are needed to maximally reduce rod strain across the lumbosacral junction with TLIF but not ALIF in long constructs. Spine J 2019; 19:1121-1131. [PMID: 30684758 DOI: 10.1016/j.spinee.2019.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Rod fracture at the lumbosacral (LS) junction remains challenging in long segment fusions and likely stems from increased LS strain. Reduction of LS instrumentation strain may help reduce fracture rates. PURPOSE The goal of this investigation was to assess the effect of supplemental posterior 4-rod (4R) construction on LS stability and rod strain compared with standard 2-rod (2R) construction in a long segment fusion model. STUDY DESIGN/SETTING Cadaveric biomechanical study. OUTCOME MEASURES Range of motion (ROM), rod strain, and sacral screw (SS) bending moments during flexion, extension, compression, lateral bending, and axial rotation. METHODS Standard nondestructive flexibility tests (7.5 Nm) were performed on 14 cadaveric specimens (L1-ilium) to assess ROM stability, rod strain, and SS bending moment of a supplemental 4R construction versus standard 2R construction. Specimens were equally divided into L5-S1 anterior lumbar interbody fusion (ALIF) or L5-S1 transforaminal lumbar interbody fusion (TLIF) groups. Three conditions were tested in each group: (1) no lumbar interbody fusion (No LIF)+2R, (2) ALIF or TLIF+2R, and (3) ALIF or TLIF+4R. Data were analyzed using repeated measures analysis of variance (ANOVA) or ANOVA. RESULTS No differences were observed between groups 1 and 2 for age, sex, bone mineral density, or baseline ROM (p>.09). Overall, TLIF+2R demonstrated greater ROM than ALIF+4R in extension (p=003), with greater rod strain in flexion, extension, and compression (p<.001), and greater SS in compression and AR (p<.04). Compared with TLIF+2R, TLIF+4R resulted in reduced rod strain in flexion, extension, compression, and LB (p<.04), as well as SS in AR (p<.001). The TLIF+4R yielded biomechanics comparable to ALIF+2R in ROM and rod strain but SS inflexion, extension, compression, and AR remained elevated (p<001). The ALIF+4R did not significantly improve ROM, rod strain, or SS (p>.11). CONCLUSIONS The use of ALIF and adding accessory rods with TLIF significantly reduced LS rod strain in a long segment cadaveric model with iliac fixation. CLINICAL SIGNIFICANCE Reducing strain could decrease the risk of failure associated with long segment fixation.
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Harris A, Kebaish KM. Sacropelvic fixation: An overview and update on current techniques. ACTA ACUST UNITED AC 2019. [DOI: 10.1053/j.semss.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
STUDY DESIGN A computed tomographic assessment. OBJECTIVE To establish morphometric data of sacral-2 alar iliac (S2AI) screw fixation in pediatric population. SUMMARY OF BACKGROUND DATA Studies on morphometric parameters of S2AI screw fixation are mostly based on adult population. The pediatric scoliosis also needs the S2AI screw fixation, however, without the previous morphometric information of among pediatric population. METHODS Computed tomography (CT) scans of 120 pediatric patients without spinal deformities are obtained and imported to Mimics software for 3D reconstruction. Then, a cylinder (radius of 3.25 mm) is drawn to imitate the screw trajectory of S2AI screw and adjusted to a maximum upward and downward angle to obtain the feasible region. Nine parameters of the S2AI screw are measured. Differences between age groups are compared and significant statistical correlations are carefully studied to determine the potentially important clinical relationships. RESULTS The mean values and standard deviations (SD) for nine parameters at the maximum upward and downward angles were determined. With age increased, the S2AI screw trajectory becomes more caudal in the coronal (44.03 ± 4.43°-53.15 ± 4.68°) and sagittal planes (50.33 ± 5.89°-57.69 ± 4.21°) and more lateral in the transverse plane (49.40 ± 5.90°-54.44 ± 2.99°), and all of the distance parameters include max-length, sacral distance, iliac width, S2 midline, iliac wing, and skin distance increased. Age has a more significant effect on other parameters than transverse angle and skin distance (P < 0.05). CONCLUSION The S2AI screw fixation could be used on pediatric population too, but the pediatric population had smaller size of pelvis than adults, surgeons should choose the smaller diameters and the shorter length of screws for pediatric population depends on their age. LEVEL OF EVIDENCE N/ A.
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Evaluation of iliac screw, S2 alar-iliac screw and laterally placed triangular titanium implants for sacropelvic fixation in combination with posterior lumbar instrumentation: a finite element study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1724-1732. [PMID: 31093749 DOI: 10.1007/s00586-019-06006-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/10/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to implement laterally placed triangular titanium implants as a technique of sacropelvic fixation in long posterior lumbar instrumentation and to characterize the effects of iliac screws, S2 alar-iliac screws and of triangular implants on rod and S1 pedicle screw stresses. METHODS Four female models of the lumbopelvic spine were created. For each of them, five finite element models replicating the following configurations were generated: intact, posterior fixation with pedicle screws to S1 (PED), with PED and iliac screws (IL), with PED and S2 alar-iliac (S2AI) screws, and with PED and bilateral triangular titanium implants (SI). Simulations were conducted in compression, flexion-extension, lateral bending and axial rotation. Rod stresses in the L5-S1 segment as well as in the S1 pedicle screws were compared. RESULTS One anatomical model was not simulated due to dysmorphia of the sacroiliac joints. PED resulted in the highest implant stresses. Values up to 337 MPa in lateral bending were noted, which were more than double than the other configurations. When compared with IL, S2AI and SI resulted in lower stresses in both screws and rods (on average 33% and 41% for S2AI and 17% and 50% for SI). CONCLUSIONS Implant stresses after S2AI and SI fixations were lower than those attributable to IL. Therefore, pedicle screws and rods may have a lower risk of mechanical failure when coupled with sacropelvic fixation via S2AI or triangular titanium implants, although the risk of clinical loosening remains an area of further investigation. These slides can be retrieved under Electronic Supplementary Material.
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Hlubek RJ, Godzik J, Newcomb AGUS, Lehrman JN, de Andrada B, Bohl MA, Farber SH, Kelly BP, Turner JD. Iliac screws may not be necessary in long-segment constructs with L5-S1 anterior lumbar interbody fusion: cadaveric study of stability and instrumentation strain. Spine J 2019; 19:942-950. [PMID: 30419290 DOI: 10.1016/j.spinee.2018.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral pseudoarthrosis and instrumentation failure is common with long-segment constructs. Optimizing lumbosacral construct biomechanics may help to reduce failure rates. The influence of iliac screws and interbody type on range of motion (ROM), rod strain (RS), sacral screw strain (SS) is not well-established. PURPOSE Investigate the effects of transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and iliac screws on long-segment lumbosacral construct biomechanics. STUDY DESIGN Biomechanical study. PATIENT SAMPLE Fourteen human cadaveric spine specimens. OUTCOME MEASURES Lumbosacral ROM, RS, and SS. METHODS Specimens were potted at L1 and the ilium. Specimens were equally divided into either an L5-S1 ALIF or TLIF group and underwent testing in the following conditions: (1) intact (2) L2-S1 pedicle screw rod fixation (PSR-S) (3) L2-ilium (PSR-I) (4) PSR-S+ALIF (ALIF-S) or TLIF (TLIF-S) (5) PSR-I + ALIF (ALIF-I) or TLIF (TLIF-I). Pure moment bending (7.5 Nm) in flexion, extension, lateral bending, axial rotation, and compressive loads (400N) were applied and ROM, SS, and RS were measured. Comparisons were performed using a one-way ANOVA (p<.05). RESULTS ALIF-S and TLIF-S provided similar decreases in ROM as TLIF-I (p>.05). Compared to PSR-S, PSR-I significantly decreased SS during bending in all directions (p<.02) but increased RS in flexion and extension (p≤.02). Anterior lumbar interbody fusion-S provided similar decreases in SS as TLIF-I in all directions (p>.40) but had significantly less RS than TLIF-I in flexion, extension, compression (p<.01). TLIF-S had more SS than TLIF-I in flexion, extension, axial rotation (p<.02), while TLIF-S had less RS only in flexion (p=.03). Compared to PSR-I, ALIF-I decreased the RS (p<.02) but TLIF-I did not (p>.67). CONCLUSIONS Iliac screws were protective of SS but increased RS at the lumbosacral junction. Constructs with ALIF and no iliac screws result in comparable SS as constructs with TLIF and iliac screws with significantly reduced RS. If iliac screws are utilized, ALIF but not TLIF reduces the iliac screw-induced RS. CLINICAL SIGNIFICANCE There is a relatively high incidence of lumbosacral instrumentation failure in adult spinal deformity. Optimizing lumbosacral construct biomechanics may help to reduce failure rates. Iliac screws induce lumbosacral rod strain and may be responsible for instrumentation failure. Constructs with lumbosacral ALIF reduce iliac-screw induced rod strain and may obviate the need for fixation to the ilium.
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Affiliation(s)
- Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Anna G U S Newcomb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jennifer N Lehrman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Bernardo de Andrada
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Samuel H Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350W. Thomas Rd., Phoenix, AZ 85013, USA.
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MacCormick LM, Chen F, Gilbertson J, Khan S, Schroder LK, Bechtold JE, Cole PA. A biomechanical study comparing minimally invasive anterior pelvic ring fixation techniques to external fixation. Injury 2019; 50:251-255. [PMID: 30447984 DOI: 10.1016/j.injury.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/18/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION INFIX and Pelvic Bridge are two new minimally invasive surgical techniques for unstable pelvic ring injuries, and they have demonstrated early clinical success in small, single-center case-series. The primary objective of this study is to gather evidence speaking to the biomechanical stability of internal bridging methods relative to external fixation, with the expectation of biomechanical equivalence. METHODS Ten human cadaveric pelvic specimens were dissected free of all skin, fat, organs, and musculature and were prepared with a partially unstable pelvic ring injury (OTA/AO 61-B). The specimens were randomized to two groups and were repaired and tested with anterior pelvic external fixation (APEF) and INFIX sequentially, or APEF and Pelvic Bridge sequentially. Testing was performed with each specimen mounted onto a servo-hydraulic testing frame with axial compression applied to the superior base of the sacrum under five axial loading/unloading sinusoidal cycles between 10 N and 1000 N at 0.1 Hz. Relative translational motion and rotation across the osteotomy site was reported as our primary outcome measures. Outcome measures were further analyzed using a Wilcoxon signed-rank test to determine differences between non-parametric data sets with significance defined as a p value < 0.05. RESULTS We found no statistical difference in translation (p = 0.237, 0.228) or rotation (p = 0.278, 0.873) at the fracture site when comparing both new constructs to external fixation. Under the imposed loading protocol, no episodes of implant failure or failure at the bone-implant interface occurred. DISCUSSION Our study provides the biomechanical foundation necessary to support future clinical trial implementation for pelvic fracture patients. While biomechanical stability of these newer, subcutaneous techniques is equivalent to APEF, the surgeon must take into account their technical abilities and knowledge of pelvic anatomy, patient-specific factors including body habitus, and the potential complications associated with each implant and the ability to avoid them.
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Affiliation(s)
- Lauren M MacCormick
- University of Minnesota, Department of Orthopaedic Surgery, 2512 S. 7th St., R200, Minneapolis, MN 55454, United States
| | - Frank Chen
- Excelen Center for Bone & Joint Research and Education, 700 10th Avenue South, Minneapolis, MN 55415, United States
| | - Jeff Gilbertson
- Regions Hospital, Department of Orthopaedic Surgery, 640 Jackson Street - MS 11503L, Saint Paul, MN 55101-2595, United States
| | - Sikandar Khan
- University of Minnesota, Department of Orthopaedic Surgery, 2512 S. 7th St., R200, Minneapolis, MN 55454, United States
| | - Lisa K Schroder
- Regions Hospital, Department of Orthopaedic Surgery, 640 Jackson Street - MS 11503L, Saint Paul, MN 55101-2595, United States
| | - Joan E Bechtold
- University of Minnesota, Department of Orthopaedic Surgery, 2512 S. 7th St., R200, Minneapolis, MN 55454, United States; Excelen Center for Bone & Joint Research and Education, 700 10th Avenue South, Minneapolis, MN 55415, United States
| | - Peter A Cole
- University of Minnesota, Department of Orthopaedic Surgery, 2512 S. 7th St., R200, Minneapolis, MN 55454, United States; Regions Hospital, Department of Orthopaedic Surgery, 640 Jackson Street - MS 11503L, Saint Paul, MN 55101-2595, United States.
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Wang Z, Boubez G, Shedid D, Yuh SJ, Sebaaly A. Is S1 Alar Iliac Screw a Feasible Option for Lumbosacral Fixation?: A Technical Note. Asian Spine J 2018; 12:749-753. [PMID: 30060386 PMCID: PMC6068408 DOI: 10.31616/asj.2018.12.4.749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022] Open
Abstract
Nonunion at the lumbosacral junction is a classic complication of long construct and deformity corrections. Iliac fixations have been extensively studied in the literature and have demonstrated superior biomechanical proprieties and lower complication rates. S2 alar iliac screws address the drawbacks of classical iliac screws but demonstrate similar biomechanical advantage. The main aim of this paper was to describe the S1 alar iliac (S1AI) screw fixation technique while evaluating our early results. S1AI screw fixation technique has the advantage of being able to achieve pelvic fixation without dissection to the S2 pedicle entry and is therefore a viable option for salvage of a failed S1 promontory screw.
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Affiliation(s)
- Zhi Wang
- Department of Orthopedic Surgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Canada
| | - Ghassan Boubez
- Department of Orthopedic Surgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Canada
| | - Daniel Shedid
- Department of Neurosurgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Canada
| | - Sung Jo Yuh
- Department of Neurosurgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Canada
| | - Amer Sebaaly
- Department of Orthopedic Surgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Canada.,Department of Neurosurgery, Spine Unit, Centre Hopitalier de l'Université de Montréal, Montréal, Canada.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Zhang N, Yu B. [Application of second sacral alar-iliac screw technique for reconstruction of spinopelvic stability]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:764-768. [PMID: 29905058 DOI: 10.7507/1002-1892.201711124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the current research progress of second sacral alar-iliac (S 2AI) screw technique for reconstruction of spinopelvic stability. Methods The recent original literature concerning development, clinical applications, anatomy, imageology, and biomechanics of S 2AI screw technique in reconstruction of spinopelvic stability was reviewed and analyzed. Results As a common clinical strategy for the reconstruction of spinopelvic stability, S 2AI screws achieve satisfactory effectiveness of lumbosacral fixation without complications which were found during the application of traditional iliac screws technique. S 2AI screw technique is more difficult to place screws by hand because of its narrow screw trajectory. Although the S 2AI screws trajectory pass through 3 layers of bone cortex, the biomechanical cadaveric study demonstrate that no statistical difference in stiffness was found between the traditional iliac and S 2AI screw in a spinopelvic fixation model. Conclusion S 2AI screw technique should be a safe and feasible method for reconstruction of spinopelvic stability in place of the traditional iliac screw technique.
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Affiliation(s)
- Nanwei Zhang
- Shantou University Medical College, Shantou Guangdong, 515041, P.R.China;Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518036, P.R.China
| | - Binsheng Yu
- Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518036, P.R.China;Shenzhen Key Laboratory of Spine Surgery, Orthopaedic Research Center, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518036,
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Khashan M, Camisa W, Berven S, Leasure J. Stand-alone anterior interbody fusion for substitution of iliac fixation in long spinal fixation constructs. Arch Orthop Trauma Surg 2018; 138:479-486. [PMID: 29288274 DOI: 10.1007/s00402-017-2865-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of distal sacral anchorage solely, in long spinal fusions, may lead to substantial complications. Extending the fixation down to the ilium and the addition of anterior column support are both used to facilitate construct stability and improve fusion rates. In the current study, we aimed to determine whether supplementation of long thoracolumbar fixation constructs with stand-alone anterior interbody fusion (ALIF) cage with embedded screws can eliminate the biomechanical need for iliac screws fixation biomechanically. METHODS Seven lumbopelvic human cadavers (L1-full pelvis) were used. All specimens were tested with the following fixation constructs: bilateral L1-S1, bilateral L1-S1 with unilateral iliac screw, and bilateral L1-S1 with bilateral iliac screw. The three constructs were tested with and without the addition of stand-alone ALIF cage. We evaluated the multidirectional rigidity and the axial S1 screw strain. RESULTS The addition of an ALIF cage solely did not affect rigidity and resulted in mixed S1 screw strain results. One iliac screw was superior to ALIF in rigidity and inferior in S1 screws strain. Bilateral iliac fixation produced similar rigidity and lower S1 screws strain than unilateral iliac fixation. When ALIF was combined with bilateral iliac screws, it resulted in equal rigidity and lower S1 screws strain. CONCLUSION Our results do not support stand-alone ALIF cage as a substitute for iliac fixation in in long posterior lumbosacral fusion. They do support the use of stand-alone ALIF for the supplementation of bilateral iliac fixation in long lumbosacral fusions.
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Affiliation(s)
- Morsi Khashan
- University of California San Francisco-Department of Orthopaedics Surgery, 400 Parnassus Ave, San Francisco, CA, 94143, USA. .,Orthopedic Division, Tel-aviv Sourasky Medical Center, 6 Wizman Street, 64239, Tel Aviv, Israel.
| | - William Camisa
- The Taylor Collaboration, 450 Stanyan St., San Francisco, CA, 94117, USA
| | - Sigurd Berven
- University of California San Francisco-Department of Orthopaedics Surgery, 400 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Jeremi Leasure
- The Taylor Collaboration, 450 Stanyan St., San Francisco, CA, 94117, USA
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Montero CS, Meneses DA, Alvarado F, Godoy W, Rosero DI, Ruiz JM. Outcomes and complications of S2 alar iliac fixation technique in patients with neuromuscular scoliosis: experience in a third level pediatric hospital. JOURNAL OF SPINE SURGERY (HONG KONG) 2017; 3:519-524. [PMID: 29354726 PMCID: PMC5760399 DOI: 10.21037/jss.2017.08.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Multiple techniques are utilized for distal fixation in patients with neuromuscular scoliosis. Although there is evidence of benefit with S2 alar iliac (S2AI) fixation, this remains controversial. The objective of this study is to evaluate the radiological outcomes and complications associated with this surgical technique in a pediatric population. METHODS An observational retrospective case series study was performed. All pediatric patients between January 2011 and February 2014 diagnosed with neuromuscular scoliosis associated with pelvic obliquity, which required surgery with fixation unto S2AI, were included. Clinical, radiological findings, and adverse events were presented with measures of central tendency. Comparison of deformity correction was carried out using a non-parametric analysis for related samples (Wilcoxon signed-rank test). Significance was set at P<0.05. RESULTS A total of 31 patients diagnosed with neuromuscular scoliosis that met inclusion criteria were analyzed. The leading cause of neuromuscular scoliosis in 23 (74.2%) patients was spastic cerebral palsy (CP). The correction of pelvic obliquity in the immediate postoperative period was of 76%, which is statistically significant. The extent of correction that patients maintained at the end of the follow-up was analyzed, and it was found that there were no significant differences in this magnitude, compared with the immediate postoperative pelvic obliquity. The mean follow-up time was 9±7 months. Regarding postoperative adverse events, occurred in 64.5% of patients, the most common outcome was pneumonia (14.8%). The overall rate of complications related to instrumentation was low (1.9%), which corresponds to one patient with an intra-articular screw in the left hip that required repositioning. CONCLUSIONS S2AI fixation for the treatment of neuromuscular scoliosis is a safe alternative, in which the onset of adverse events is related to the comorbidities of patients instead of the surgical procedure itself. An approximate correction of 76% of pelvic obliquity is maintained during the follow-up.
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Affiliation(s)
- Carlos Segundo Montero
- Orthopedics and Traumatology Department, Spine Surgery Service, Instituto de Ortopedia Infantil Roosevelt, Bogota D.C., Colombia
| | - David Alberto Meneses
- Orthopedics and Traumatology Department, Spine Surgery Service, Instituto de Ortopedia Infantil Roosevelt, Bogota D.C., Colombia
| | - Fernando Alvarado
- Orthopedics and Traumatology Department, Spine Surgery Service, Instituto de Ortopedia Infantil Roosevelt, Bogota D.C., Colombia
| | - Wilmer Godoy
- Orthopedics and Traumatology Department, Spine Surgery Service, Instituto de Ortopedia Infantil Roosevelt, Bogota D.C., Colombia
| | - Diana Isabel Rosero
- Orthopedics and Traumatology Department, Spine Surgery Service, Instituto de Ortopedia Infantil Roosevelt, Bogota D.C., Colombia
| | - Jose Manuel Ruiz
- Orthopedics and Traumatology Department, Spine Surgery Service, Instituto de Ortopedia Infantil Roosevelt, Bogota D.C., Colombia
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