Long fusion to the pelvis with S2-alar-iliac screws can induce changes in pelvic incidence in adult spinal deformity patients: analysis of predictive factors in a retrospective cohort

Tseng, Changchun; Liu, Zhen; Bao, Hongda; Li, Jie; Zhao, Zhihui; Hu, ZongShang; Qiu, Yong; Zhu, Zezhang

doi:10.1007/s00586-018-5738-2

Cited by 20 publications

(26 citation statements)

References 24 publications

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“…Although that was not the focus of this present study, another important aspect regarding the employment of the S2AI technique is the possible modification in the relations of the spinopelvic measures caused by the implant position in the lumbopelvic region. It is said that pelvic incidence is a constant morphological parameter after skeletal maturity; however, several recent studies have questioned these data [21,22]. This fact deserves future research, including 3D analysis.…”

Section: Discussionmentioning

confidence: 96%

Comparative tomographic study of the S2-alar-iliac screw versus the iliac screw

Tavares¹,

Souza²,

Araújo³

et al. 2018

Eur Spine J

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Aims Iliac screws and S2-alar-iliac screws provide adequate mechanical stability for the fixation of lumbosacral spine pathologies, which has led to a significant increase in the use of these techniques in the routine practice of spine surgeons. However, studies on the ideal technical positioning for both techniques are limited. Study design This is an observational, retrospective, analytical descriptive study. Objective To analyze, describe and compare the insertion and positioning parameters of the S2-alar-iliac and iliac screw techniques in adult patients without spinal deformities. Methods The present study comprises a retrospective analysis of lumbosacral computed tomography images selected continuously in 2016 from 25 patients at a university hospital. Mann-Whitney-Shapiro-Wilk tests were performed. Data reliability was assessed using intraclass correlation. Results The mean length of the iliac screw was greater than that of the S2-alar-iliac screw, and the S2-alar-iliac screw sat 20.5 mm deeper than the iliac screw. The mean of the greatest bone thickness for the iliac screw was 20.72 mm; that of the S2-alar-iliac screw was 23.24 mm. The mean distance from the iliac screw entry point to the skin was 32.46 mm, and the mean distance from the S2-alar-iliac screw entry point to the skin was 52.87 mm. Conclusion The trajectory of the S2-alar-iliac screws studied via computed tomography was greater in terms of bone thickness and deeper relative to the skin compared with the iliac screws. The S2-alar-iliac technique may have desirable clinical advantages in terms of the diameter of the screws and reduced protrusion when used in adults. Graphical abstract These slides can be retrieved from Electronic supplementary material.

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Section: Discussionmentioning

confidence: 96%

Comparative tomographic study of the S2-alar-iliac screw versus the iliac screw

Tavares¹,

Souza²,

Araújo³

et al. 2018

Eur Spine J

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“…Most surgeons suggest PI is the key parameter needed to estimate the ideal LL to be restored after spine surgery. However, the current literature [37][38][39] questions this characteristic of constant PI, claiming that PI may change under certain circumstances. In addition, PI could be changed by motion of the SIJ if it is influenced by various forces due to joint motion or position during supine, sitting, or locomotion behaviors.…”

Section: Discussionmentioning

confidence: 99%

Use of iliac screw associated with more correction of lumbar lordosis than S2-alar-iliac screw for adult spinal deformity

Luo

Kim

et al. 2021

BMC Musculoskelet Disord

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Background To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation. Methods A retrospective review of consecutive patients who underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change < 5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared. Results A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26°, 39.8 ± 13.8°) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9°, 30.3 ± 9.9°) (p < 0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p < 0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p < 0.05) and (16.1% vs 3.6%, p < 0.05). Conclusions Compared with the S2AI technique, the IS technique usable larger cantilever force demonstrated more correction of lumbar lordosis, and possible increase in pelvic incidence. Further study is warranted to clarify the clinical impaction of these results.

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“…Despite that we studied female only patients, the conclusion of this study may be inferred to male patients with spinal pathologies since male patients were enrolled in some previous studies reporting dynamic PI. 7,13 Several limitations are present in the present study. First, the identification of altered anatomies of SI joint should be confirmed by lumbosacral CT scan with an age-matched control group, which is not applicable for recruiting such healthy population, weakening the reliability of results.…”

Section: Discussionmentioning

confidence: 84%

Position-related Change of Pelvic Incidence Depends on the Nonfused Sacroiliac Joint in Patients with Degenerative Spinal Diseases

Bao

Zhang²,

Shu³

et al. 2020

Spine

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A retrospective cross-sectional study.Objective. This study aims to determine whether the sacroiliac (SI) joint motion correlated to pelvic incidence (PI) change from standing to supine position in patients with degenerative spinal diseases. Summary of Background Data. PI was found an unstable parameter after adolescence as the fixed nature of PI was challenged by several studies. The SI joint has been shown to have some motion, age-related degenerative changes of cartilage and SI ligaments contribute to SI joint instability. Methods. The study contains both specimen study and radiographic study. One human specimen was acquired, on which PI was measured with different sacrum-ilium positions. In radiographic study, patients with old thoracolumbar fracture, lumbar disc herniation, stenosis, and spondylolisthesis were included. Ankylosing spondylitis (AS) patients were also included as control group. PI was measured on standing x-rays and scanogram of computed tomography images in supine position.Results. Specimen study result revealed that SI motion would lead to the change of PI with fixed pelvic thickness. In radiographic study, 101 patients with different etiology and 30 AS patients were included. After stratifying into different age groups, standing PI was significantly larger than supine PI in each age groups (P ¼ 0.002, <0.001, and <0.001, respectively).In patients with degenerative diseases, PI was significantly larger on standing position than that on supine position. DPI showed no significant difference across etiologies. However, in AS patients, standing PI and supine PI revealed no significant difference (P ¼ 0.528). Conclusion.Mobile SI joint may be the cause of increased PI in the aging spine. The dynamic change of PI is etiologyindependent if the SI joint was not fused. Older patients have greater position-related change of PI.

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Long fusion to the pelvis with S2-alar-iliac screws can induce changes in pelvic incidence in adult spinal deformity patients: analysis of predictive factors in a retrospective cohort

Abstract: Our study showed that PI decreased in 55% of ASD patients after spinal surgery using S2AI screws. Greater preoperative PI-LL mismatch and PI, as well as lumbar kyphosis, were associated with postoperative change in PI. These slides can be retrieved under Electronic Supplementary Material.

Cited by 20 publications

References 24 publications

Comparative tomographic study of the S2-alar-iliac screw versus the iliac screw

Comparative tomographic study of the S2-alar-iliac screw versus the iliac screw

Use of iliac screw associated with more correction of lumbar lordosis than S2-alar-iliac screw for adult spinal deformity

Position-related Change of Pelvic Incidence Depends on the Nonfused Sacroiliac Joint in Patients with Degenerative Spinal Diseases

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