Modified iliac screw fixation: technique and clinical application

Sohn, Seil; Chung, Chun Kee; Kim, Yongjung Jay; Kim, Chi Heon; Park, Sung Bae; Kim, Hye-Jin

doi:10.1007/s00701-016-2772-x

Cited by 22 publications

(16 citation statements)

References 16 publications

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“…However, this was not the case in our iliac screw cohort. Despite new technical reports on reducing iliac screw prominence, S2AI screws do not harbor this issue at all [21]. Typically, and as our series does, such surgeries harbor not only an increased risk of perioperative surgical but also medical complications [22], despite the outcome usually being affected [23].…”

Section: Discussionmentioning

confidence: 64%

Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

et al. 2020

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Lumbosacral instrumentation continues to be challenging due to complex biomechanical force distributions and poor sacral bone quality. Various techniques have therefore been established. The aim of this study was to investigate the outcome of patients treated with S2-alar-iliac (S2AI), S2-alar (S2A), and iliac (I) instrumentation as the most caudal level. Sixty patients underwent one of the 3 techniques between January 2012 and June 2017 (S2AI 18 patients, S2A 20 patients, I 22 patients). Mean age was 70.4 ± 8.5 years. Screw loosening (SL) and sacroiliac joint (SIJ) pain were evaluated during the course at 3-month and maximum follow-up (FU). All patients completed 3-month FU, the mean FU period was 2.5 ± 1.5 years (p = 0.38), and a median of 5 segments was operated on (p = 0.26), respectively. Bone mineral density (BMD), derived opportunistically from computed tomography (CT), did not significantly differ between the groups (p = 0.66), but cages were more frequently implanted in patients of the S2A group (p = 0.04). SL of sacral or iliac screws was more common in patients of the S2A and I groups compared with the S2AI group (S2AI 16.7%, S2A 55.0%, I 27.3% of patients; p = 0.03). SIJ pain was more often improved in the S2AI group not only after 3 months but also at maximum FU (S2AI 61.1%, S2A 25.0%, I 22.7% of patients showing improvement; p = 0.02). Even in shorter or mid-length lumbar or thoracolumbar constructs, S2AI might be considered superior to S2A and I instrumentation due to showing lower incidences of caudal SL and SIJ pain.

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Section: Discussionmentioning

confidence: 64%

Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

et al. 2020

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“…This technique has two important advantages: (1) it significantly decreases screw head irritation and (2) a connector rod is easy to apply without the necessity of offsetting the connecting rod, which can save operative time [16]. However, we removed implants in both of the groups 6 months after surgery to prevent pedicle screw damage.…”

Section: Discussionmentioning

confidence: 99%

Traditional versus Minimally Invasive Spinopelvic Fixation for Sacral Fracture Treatment in Vertically Unstable Pelvic Fractures

Tsai

Chou

2022

JPM

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Purpose: Numerous different fixation techniques are used to treat vertical shear sacral fractures. We report our experience with spinopelvic fixation using a minimally invasive technique. Methods: Thirty-eight patients with vertical pelvic and sacral fractures were treated with spinopelvic fixation (traditional open method, n = 21; minimally invasive technique, n = 17). Intergroup comparisons and statistical analysis were performed for intraoperative blood loss, operative time, post-operative radiographic grading, post-operative functional score, and complication rates. Results: Patients treated with the minimally invasive technique had a significantly shorter operative time (−52 min, p = 0.022), reduced blood loss volume (−287 mL, p < 0.001), and better cosmetic appearance (p < 0.05) than those in the traditional open group. There were no significant intergroup differences in post-operative radiographic grading (p = 0.489) or post-operative functional scores (p = 0.072). The complication rate was lower in the minimally invasive group (1/17 patients) than in the traditional open group (2/21 patients). Conclusions: Minimally invasive spinopelvic fixation is a viable treatment for sacral fractures and can reduce blood loss and operative time.

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“…technique easy and the learning curve steep. 9,22,[25][26][27] The mentioned advantages are more conducive to the development of navigation and minimally invasive techniques. [30][31][32] Recent studies have indicated that this technique may be a preferred method in spinopelvic fixation.…”

Section: Limitationsmentioning

confidence: 99%

Modified Iliac Screw in Lumbopelvic Fixation After Sacral Tumor Resection: A Single-Center Case Series

Huang

Cai

Cheng

et al. 2023

Operative Neurosurgery

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BACKGROUND: Traditional iliac screw, S2-alar iliac screw, and modified iliac screw are the 3 common techniques for lumbopelvic fixation. The application of the modified iliac technique in sacral spinal tumors has been rarely reported. OBJECTIVE: To report the feasibility and safety of modified iliac screws after sacral tumor resection and their preliminary clinical outcomes. METHODS: Twenty-seven patients who underwent sacral tumor resection with modified iliac screw fixation between August 2017 and August 2021 at our center were clinically and radiographically evaluated. RESULTS: A total of 59 iliac screws were inserted by freehand according to the anatomic landmarks. The mean operation time was 207 minutes (range, 140-435 minutes). The average estimated blood loss was 1396 mL (300-4200 mL). Computed tomography scans showed that 2 (3.4%) screws penetrated the iliac cortex, indicating a 96.6% implantation accuracy rate. There were no iatrogenic neurovascular or visceral structure complications observed. The mean minimal distances from the screw head to the skin were 24.9 and 25.8 mm on the left and right sides, respectively. The mean minimal distances from the screw head to the horizontal level of the posterior superior iliac spine were 7.9 and 8.3 mm on the left and right sides, respectively. Two patients (7.4%) underwent reoperation for wound infection. At the latest follow-up, no patient had complications of screw head prominence, pseudarthrosis, or instrument failure. CONCLUSION: The modified iliac screw is characterized by its minimal invasiveness and simplicity of placement. It is an ideal alternative for lumbopelvic fixation after sacral tumor resection.

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Modified iliac screw fixation: technique and clinical application

Cited by 22 publications

References 16 publications

Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

Traditional versus Minimally Invasive Spinopelvic Fixation for Sacral Fracture Treatment in Vertically Unstable Pelvic Fractures

Modified Iliac Screw in Lumbopelvic Fixation After Sacral Tumor Resection: A Single-Center Case Series

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