Comparative radiological outcomes and complications of sacral-2-alar iliac screw versus iliac screw for sacropelvic fixation

Gao, Ziwei; Sun, Xiaojuan; Chen, Chao; Teng, Zhaowei; Xu, Baoshan; Ma, Xinlong; Wang, Zheng; Yang, Qiang

doi:10.1007/s00586-021-06864-7

Cited by 22 publications

(11 citation statements)

References 53 publications

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“…Pelvic obliquity and curve correction is often comparable at short-term follow-up appointments (ie, 6-week and 1-year postoperative) among these various spinopelvic fixation techniques; however, at long-term follow-up appointments (ie, 5 years postoperative), SAI screws demonstrated greater maintenance of correction, as well as lower complication rates. 8,9,11,12 Our study further confirms that SAI screws are able to maintain pelvic obliquity and curve correction, and have a relatively low complication rate at long-term follow-up.…”

Section: Discussionsupporting

confidence: 77%

Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up

Mun

Vankara

Suresh

et al. 2022

Journal of Pediatric Orthopaedics

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Introduction: Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up. Methods: We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections. Results: Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications. Conclusions: SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time. Level of Evidence: Level IV.

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Section: Discussionsupporting

confidence: 77%

Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up

Mun

Vankara

Suresh

et al. 2022

Journal of Pediatric Orthopaedics

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“…As well, Elder et al, 11 reported that in S2AI group the mean difference VAS was 2.5 ± 2.8. Furthermore, the meta-analysis by Gao et al, 13 reported that in S2AI group the mean difference VAS was 2.52.…”

Section: Discussionmentioning

confidence: 98%

Study of Sacroiliac fixation in patients with sacroiliitis associated with L5 Lythesis

Gabal¹,

Zahy

Ewis

2022

Al-Azhar International Medical Journal

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Background: Chronic low back discomfort is frequently brought on by the sacroiliac joint. The SIJ may be involved in 15-30% of patients who attend for examination of low back pain. Aim of the work: This study evaluates sacroiliac fixation in patients with sacroiliitis associated with L5 lythesis. Patients and methods: In this prospective and retrospective study, 10 individuals with spinal disorders were examined. Ten patients with mechanical sacroiliac joint discomfort underwent sacroiliac joint fixation. Results: Overall, this series' results showed that 7 patients (or 70%) had fully resolved their problems, 2 patients (or 20%), partially improved, and 1 patient (or 10%), had not. Conclusion: Sacroiliac fixation was safe and efficient in the treatment of patients with sacroiliitis associated with L5 lythesis. Currently, one of the most widely used methods for spinopelvic fusion is S2AI screw fixation. Significantly fewer clinical and radiographic problems are linked to the S2AI method . We need further comparison research with larger sample sizes and longer followups to corroborate our findings and pinpoint the risk factors for unfavourable outcomes.

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“…The systematic review of biomechanical studies by Hirase et al suggested that the stress on instrumentations and surrounding iliac bone was lower in S2AI screw fixation than iliac screw ( Hirase et al, 2022 ). The meta-analysis by Gao et al reported that using S2AI screw could adequately maintain the deformity correction and significantly decrease the risk of mechanical complications compared with the iliac screw ( Gao et al, 2021 ). Also, the placement of S2AI screw does not require dissection as extensive as iliac screw; therefore, the incidence of skin breakdown and would infection was lower.…”

Section: Discussionmentioning

confidence: 99%

“…Although the application of SPF, the incidence of implant failure is still unsatisfactory, with reported rates ranging from 12.0% to 46.9% ( Park et al, 2021b ; Gao et al, 2021 ). In recent cohort studies, advanced SPF technique by multiple pelvic screws or multirod construct has been recommended following long spinal fusion to stabilize the LSJ further, protect the primary rod and screws, and reduce the persistent motion of SIJ ( Uotani et al, 2021 ; Lee et al, 2022a ; Lee et al, 2022b ).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Yang

Pan

Hai

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Posterior long spinal fusion was the common procedure for adult spinal deformity (ASD). Although the application of sacropelvic fixation (SPF), the incidence of pseudoarthrosis and implant failure is still high in long spinal fusion extending to lumbosacral junction (LSJ). To address these mechanical complications, advanced SPF technique by multiple pelvic screws or multirod construct has been recommended. This was the first study to compare the biomechanical performance of combining multiple pelvic screws and multirod construct to other advanced SPF constructs for the augmentation of LSJ in long spinal fusion surgery through finite element (FE) analysis.Methods: An intact lumbopelvic FE model based on computed tomography images of a healthy adult male volunteer was constructed and validated. The intact model was modified to develop five instrumented models, all of which had bilateral pedicle screw (PS) fixation from L1 to S1 with posterior lumbar interbody fusion and different SPF constructs, including No-SPF, bilateral single S2-alar-iliac (S2AI) screw and single rod (SS-SR), bilateral multiple S2AI screws and single rod (MS-SR), bilateral single S2AI screw and multiple rods (SS-MR), and bilateral multiple S2AI screws and multiple rods (MS-MR). The range of motion (ROM) and stress on instrumentation, cages, sacrum, and S1 superior endplate (SEP) in flexion (FL), extension (EX), lateral bending (LB), and axial rotation (AR) were compared among models.Results: Compared with intact model and No-SPF, the ROM of global lumbopelvis, LSJ, and sacroiliac joint (SIJ) was decreased in SS-SR, MS-SR, SS-MR, and MS-MR in all directions. Compared with SS-SR, the ROM of global lumbopelvis and LSJ of MS-SR, SS-MR, and MS-MR further decreased, while the ROM of SIJ was only decreased in MS-SR and MS-MR. The stress on instrumentation, cages, S1-SEP, and sacrum decreased in SS-SR, compared with no-SPF. Compared with SS-SR, the stress in EX and AR further decreased in SS-MR and MS-SR. The most significantly decreased ROM and stress were observed in MS-MR.Conclusion: Both multiple pelvic screws and multirod construct could increase the mechanical stability of LSJ and reduce stress on instrumentation, cages, S1-SEP, and sacrum. The MS-MR construct was the most adequate to reduce the risk of lumbosacral pseudarthrosis, implant failure, and sacrum fracture. This study may provide surgeons with important evidence for the application of MS-MR construct in the clinical settings.

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Comparative radiological outcomes and complications of sacral-2-alar iliac screw versus iliac screw for sacropelvic fixation

Cited by 22 publications

References 53 publications

Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up

Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up

Study of Sacroiliac fixation in patients with sacroiliitis associated with L5 Lythesis

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

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