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.
Background: The purpose of this study was to report our surgical experience in patients with lumbosacral degenerative diseases who underwent low-profile posterior lumbosacral interbody fusion (LP-PLSIF) and analyze surgery-related indicators and postoperative outcomes. Methods: This study included nine patients with lumbosacral degenerative diseases who underwent LP-PLSIF between March 2021 and March 2022. Perioperative clinical presentations, operative variables, and perioperative complications were recorded. Results: Complete and authentic clinical data, including satisfactory surgical efficacy, short hospitalization time, and low estimated blood loss were obtained. The condition and muscle strength along with preoperative neurological deficits improved in all the patients, and no postoperative neurological complications occurred. The mean operation time was 156 min (range, 120–220 min), and the average wound length was 5.9 cm (range, 5–9 cm). There were no postoperative complications, such as nerve root compression, dural tears, or wound infection. All patients showed an improvement of approximately four points on the visual analog scale after surgery. The mean Oswestry Disability Index after 6-month follow-up (19.7%) was significantly lower than that at the preoperative follow-up (62.8%). In addition, the mean Japanese Orthopedic Association score was 12.4 before surgery and improved to 22.7 after surgery. Conclusions: LP-PLSIF may be effective in protecting the soft tissue, paravertebral muscle, and superior facet joint along with maintaining stress balance in the lumbosacral region. In conclusion, LP-PLSIF was efficient in enhancing the fusion rates and eventually provided a minimally invasive, effective, and safe spinal fusion surgery for patients with osteoporosis.
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