Comparative Study of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screw for Adult Spine Deformities

Uotani, Koji; Tanaka, Masato; Sonawane, Sumeet; Ruparel, Sameer; Fujiwara, Yoshihiro; Arataki, Shinya; Yamauchi, Taro; Misawa, Haruo

doi:10.1016/j.wneu.2021.09.048

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…S2 AI screws were loosening two years after surgery at a high rate, which induced S1 screw loosening, nonunion at L5/S1, and rod fracture 3,4 . To prevent these problems, surgeons increasingly use dual iliac screws and dual sacral AI screws 5–7 . These dual screws provide a more rigid anchor of the pelvis and decreased complications such as S1 screw loosening, nonunion at L5/S1, and rod fracture.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress

Kozaki

Mell

Samartzis

et al. 2023

Spine

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Study Design. This study compared hip stress among different types of lumbopelvic fusion based on finite element (FE) analysis. Objective. We believe that the number and placement of S2 AI screws, and whether the screws loosen likely influence hip joint stress in the finite element model. Summary of Background Data. Spinopelvic fixation hs been shown to increase the risk of progression for hip joint osteoarthritis. The biomechanical mechanism is not well understood. We hypothesize that the rigid pelvic fixation may induce stress at adjacent joints. Methods. A three-dimensional nonlinear FE model was constructed from the L4 vertebra to the femoral bone. From the intact model, we made four fusion models, each with different lower vertebrae instrumentation: 1) L4-S1 fusion; 2) L4-S2 AI screw fixation; 3) L4-S2 AI screw fixation with S2 AI screw loosening; and 4) L4-S1 and dual AI screw fixation (DSIF). A compressive load of 400 N was applied vertically to the L4 vertebra, followed by an additional 10 Nm bending moment about different axes to simulate either flexion, extension, left lateral bending, or right axial rotation. The distal femoral bone was completely restrained. von Mises stress and angular motion were analyzed across the hip joints within each fusion construct model. Results. Hip joint cartilage stress, and range of motion increased for all postures as pelvic fixation became more rigid. The DSIF model increased stress and angular motion at the hip joint more than SIF model. Our results suggest that more rigid fixation of the pelvis induces additional stress on the hip joint, which may precipitate or accelerate adjacent joint disease. Conclusion. Dual sacral AI fixation led to the highest stress, while loosening of S2 AI decreased stress on the hip joint. This study illustrates that more rigid fixation among lumbosacral fusion constructs increases biomechanical stress on the hip joints.

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Section: Discussionmentioning

confidence: 99%

“…S2 AI screw loosening can also lead to L5/S1 nonunion. Some authors advocated the use of bilateral dual sacral AI screws or dual iliac screws to achieve a more rigid construct, thought to both improve the fusion rate and maintain sagittal and coronal axis corrections 5–7 …”

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confidence: 99%

Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress

Kozaki

Mell

Samartzis

et al. 2023

Spine

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“…Although SPF indeed reinforces the construct stiffness, 12.0%–46.9% of implant failure rate has been reported by previous studies ( Park et al, 2021b ; Gao et al, 2021 ). To reduce the incidence of mechanical complications, multiple pelvic screws or multirod construct have been applied as an advanced SPF technique ( Uotani et al, 2021 ; Lee et al, 2022a ; Lee et al, 2022b ; Tang et al, 2022 ). The current study revealed that both multiple pelvic screws and multirod construct could increase the mechanical stability of LSJ, reduce strain on the lumbosacral rod, and protect the S1-PS and sacrum.…”

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 ). However, there was only one small-size cohort study reporting the application of combining the multiple pelvic screws and multirod construct, without any control groups ( Shen et al, 2018 ).…”

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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“…Spinal injuries often occur in the thoracolumbar segment, accounting for 28% to 58% of spinal injuries. [3,4] Thoracolumbar fractures often lead to patients with thoracolumbar instability. [5,6] If internal fixation treatment is not carried out in time, it will further lead to the aggravation of spinal cord injury and paralysis of the corresponding segments, causing huge losses and burdens to patients, their families, and society.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

Zhang

Song

et al. 2022

Medicine

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Background: To explore the biomechanical characteristics of 2 posterior bilateral pedicle screw fixation methods using finite element analysis.Methods: A normal L3-5 finite element model was established. Based on the verification of its effectiveness, 2 different posterior internal fixation methods were simulated: bilateral pedicle screws (model A) were placed in the L3 and L5 vertebral bodies, and bilateral pedicle screws (model B) were placed in the L3, L4, and L5 vertebral bodies. The stability and stress differences of intervertebral discs, endplates, screws, and rods between models were compared.Results: Compared with the normal model, the maximum stress of the range of motion, intervertebral disc, and endplate of the 2 models decreased significantly. Under the 6 working conditions, the 2 internal fixation methods have similar effects on the stress of the endplate and intervertebral disc, but the maximum stress of the screws and rods of model B is smaller than that of model A.Conclusions: Based on these results, it was found that bilateral pedicle screw fixation in 2 vertebrae L3 and L5 can achieve similar stability as bilateral pedicle screw fixation in 3 vertebrae L3, L4, and L5. However, the maximum stress of the screw and rod in model B is less than that in model A, so this internal fixation method can effectively reduce the risk of fracture. The 3-dimensional finite element model established in this study is in line with the biomechanical characteristics of the spine and can be used for further studies on spinal column biomechanics. This information can serve as a reference for clinicians for surgical selection.

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Comparative Study of Bilateral Dual Sacral-Alar-Iliac Screws versus Bilateral Single Sacral-Alar-Iliac Screw for Adult Spine Deformities

Cited by 12 publications

References 19 publications

Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress

Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress

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

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

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