Biomechanical evaluation of sacroiliac joint fixation with decortication

Shih, Yushane C.; Beaubien, Brian P.; Chen, Qingshan; Sembrano, Jonathan N.

doi:10.1016/j.spinee.2018.02.016

Cited by 23 publications

(24 citation statements)

References 27 publications

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“…More broadly, multiple biomechanical studies have demonstrated that a single SI joint screw results in less stability than two screws across the joint. [27][28][29] Collectively, the above-mentioned studies corroborate the hypothesis that an increased number of fixation points increases SI joint stability.…”

supporting

confidence: 73%

Biomechanical effects of a novel posteriorly placed sacroiliac joint fusion device integrated with traditional lumbopelvic long-construct instrumentation

Pereira

Lehrman

Sawa

et al. 2021

Journal of Neurosurgery: Spine

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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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supporting

confidence: 73%

Biomechanical effects of a novel posteriorly placed sacroiliac joint fusion device integrated with traditional lumbopelvic long-construct instrumentation

Pereira

Lehrman

Sawa

et al. 2021

Journal of Neurosurgery: Spine

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“…(5) The inner diameter of the guide hole must be slightly larger than the diameter of the K-wire in order to pass the K-wire through easily. (6) We do not compress the template, because the consequent deformation would reduce the accuracy. (7) When the K-wire is drilled through the guide hole, we should drill the K-wire along the guide hole gently.…”

Section: Discussionmentioning

confidence: 99%

A Novel Patient-Specific Three-Dimensional Printing Template Based on External Fixation for Pelvic Screw Insertion

Zhou

Tao

Pan

et al. 2020

Preprint

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Abstract (1) Background: To investigate the clinical effect of the novel patient-specific 3D printing templates based on external fixation for pelvic screw insertion. (2) Methods: We retrospectively studied 8 patients with pelvic fractures who were treated using this novel template from July 2017 to July 2018. During the operation, the screws were inserted with the aid of the template. The operative time per screw, radiation exposure time, and accuracy of the screw insertions as evaluated by post-operative CT scans were analyzed statistically and compared with previous outcomes using the fluoro-navigation technique. (3) Results: In the template group, a total of 9 pubis screws and 6 sacroiliac screws were inserted. The mean surgical time was 11.3 min/screw and the mean X-ray exposure time was 11.8 ± 3.9 s/screw. The mean deviation distance and angle between the actual and planned screw position was 2.6 ± 0.2 mm and 2.0 ± 0.3 degrees, and blood loss during the surgery was 12.2 ml/screw. No superficial and deep infections and no patient sustained recognized neurologic, vascular, or urologic injury occurred in the template group. The surgical time and X-ray exposure time was less than that in the fluoro-navigation group((P < 0.05) (4) Conclusions: The patient-specific template based on external fixation can guide the insertion of the pelvic screw accurately, safely and invasively and significantly reduce operation and radiation exposure time.

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“…They observed that unilateral and bilateral SIJ fusions using iFuse implants provided significant reduction in SIJ motions, compared to being intact in all modes. 40 Shih et al 41 performed an in vitro study to evaluate 2 techniques for placing primary (12.5-mm) and secondary (8.5-mm) threaded rods (Zyga Technology) across the SIJ ( Figure 6). They performed cyclic loading after placement of the primary implant at S1 and a secondary implant at either S1 or S2.…”

Section: In Vitro Studiesmentioning

confidence: 99%

“…Test setup side view (left) and anterior view (right) under bending moment in materials testing system machine 41. …”

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confidence: 99%

Biomechanics of the Sacroiliac Joint: Surgical Treatments

et al. 2020

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Background: Fixation is one of the most common surgical techniques for the treatment of chronic pain originating from the sacroiliac joint (SIJ). Many studies have investigated the clinical outcomes and biomechanics of various SIJ surgical procedures. However, the biomechanical literature points to several issues that need to be further explored, especially for the devices used in minimally invasive surgery of the SIJ. This study (part II) aims to assess biomechanical literature to understand the existing information as it relates to efficacies of the surgical techniques and the gaps in the knowledge base. Part I reviewed basic anatomy and mechanics of the SIJ joint, including difference between males and females, and causes of pain emanating from these joints. Methods: A thorough literature review was performed pertaining to studies related to SIJ fixation techniques and the biomechanical outcomes of the surgical procedures. Results: Fifty-five studies matched the search criteria and were considered for the review. These articles predominantly pertained to the biomechanical outcomes of the minimally invasive surgery with different instrumentation systems and surgical settings. Conclusions: The SIJ is one of the most overlooked sources of lower back pain. The joint is responsible for the pain in 15% to 30% of people suffering from lower back pain. Various studies have investigated the clinical outcomes of different surgical procedures intended to improve the pain and quality of life following surgery. The data show that these techniques are indeed effective. However, clinical studies have raised several issues, like optimal number and positioning of implants, unilateral versus bilateral placements, adjacent segment disease, implant designs, and optimal location of implants with respect to variations in bone density across the SIJ. Biomechanical studies using in vitro and in silico techniques have addressed some of these issues. Studies also point out the need for additional investigations for a better understanding of the underlying mechanics for the improved long-term surgical outcomes. Further long-term clinical follow-ups are essential as well. This review presents pertinent findings.

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Biomechanical evaluation of sacroiliac joint fixation with decortication

Cited by 23 publications

References 27 publications

Biomechanical effects of a novel posteriorly placed sacroiliac joint fusion device integrated with traditional lumbopelvic long-construct instrumentation

Biomechanical effects of a novel posteriorly placed sacroiliac joint fusion device integrated with traditional lumbopelvic long-construct instrumentation

A Novel Patient-Specific Three-Dimensional Printing Template Based on External Fixation for Pelvic Screw Insertion

Biomechanics of the Sacroiliac Joint: Surgical Treatments

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