P115. Low Profile Pelvic Fixation Anatomic Parameters for Sacral Alariliac Fixation vs. Traditional Iliac Fixation

Chang, Tai-Li; Sponseller, Paul D.; Kebaish, Khaled M.; Fishman, Elliot K.

doi:10.1016/j.spinee.2008.06.757

Cited by 84 publications

(176 citation statements)

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“…In addition, the S2AI screw head can be aligned with the S-1 pedicle screw and rostral instrumentation without the use of bulky connector devices, given that the starting point is directly inferior to the superior articular facet of S-1 and in line with the pedicles of the lumbar spine. 6 None of the 23 patients in our cohort who received S2AI screws required removal of the pelvic fixation for pain or screw fracture.…”

Section: Painful Hardware Prominencementioning

confidence: 90%

“…The starting point for an S2AI screw is located approximately 5 mm caudal and 2-3 mm lateral to the first sacral foramen, 28 which is ap- proximately 15 mm deeper than the entry point of an iliac bolt on the posterior superior iliac spine. 6 This enables S2AI screws to be lower profile with more muscle and fascial coverage. Because the starting point is more medial on the sacrum, less dissection of paraspinal muscles and the subcutaneous tissues over the iliac spine is required.…”

Section: Painful Hardware Prominencementioning

confidence: 99%

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Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mazur¹,

Ravindra²,

Schmidt³

et al. 2015

SPI

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OBJECT S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques. METHODS The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors. RESULTS Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation. CONCLUSIONS Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.

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Section: Painful Hardware Prominencementioning

confidence: 90%

Section: Painful Hardware Prominencementioning

confidence: 99%

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mazur¹,

Ravindra²,

Schmidt³

et al. 2015

SPI

View full text Add to dashboard Cite

show abstract

“…men). 3,16,17,29 Because there is no previous report of using a combination of S-1 and S-2 SAI screws, we proposed to review our experience with the technique involving combined use of S-1 and S-2 SAI screws as a salvage procedure for definitive pelvic fixation after pseudarthrosis in the lumbosacropelvic junction.…”

Section: Department Of Neurosurgery University Of Illinois College Omentioning

confidence: 99%

Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability

Mattei

Fassett²

2013

SPI

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Lumbosacropelvic pseudarthrosis after long spinal fusions for treatment of adult degenerative scoliosis remains a challenging condition. Moreover, although pelvic fixation with iliac screws is widely used in deformity surgery to provide a biomechanically strong distal anchor for long thoracolumbar constructs, there are very few options available after failed pelvic fixation with iliac screws. The authors conducted a retrospective review of the surgical charts and imaging findings of patients subjected to revision surgery for lumbosacropelvic pseudarthrosis from August 2011 to August 2012. This review identified 5 patients in whom a salvage technique combining both S-1 and S-2 sacral alar-iliac (SAI) screws had been performed. In this technical note, the authors present a detailed anatomical discussion and an appraisal of the sequential intraoperative steps of this new technique involving a combination of S-1 and S-2 SAI screws. The discussion is illustrated with a surgical case in which this technique was used to treat a patient with pseudarthrosis that had developed after fixation with classic iliac screws. In conclusion, although S-2 SAI screws have previously been reported as an interesting alternative to classic iliac wing screws, this report is the first on the use of combined S-1 and S-2 SAI screws for pelvic fixation as a salvage technique for lumbosacropelvic instability. According to the reported experience, this technique provides a biomechanically robust construct for definitive pelvic fixation during revision surgeries in the challenging scenarios of pseudarthrosis and instability of the lumbosacropelvic region.

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“…These screws are inserted with a starting point 1 mm caudal and 1 mm distal to the S1 dorsal foramen. This starting point makes them inline with S1 promontory screws and lumbar pedicle screws, thus eliminating the need for cross-connectors [86,87]. A computed tomographic analysis in skeletally mature adolescents demonstrated that their entry point is also 15 mm deeper than the PSIS starting point, thus potentially minimizing implant prominence when compared to Galveston or iliac screws fixation techniques [86].…”

Section: Sacral Alar Iliac Techniquementioning

confidence: 99%

Pelvic fixation for neuromuscular scoliosis deformity correction

Dayer¹,

Ouellet

Saran

2012

Curr Rev Musculoskelet Med

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Pelvic fixation is most frequently indicated in the pediatric population for the treatment of neuromuscular scoliosis with significant pelvic obliquity. Neuromuscular scoliosis surgery is associated with a high risk of complications, and this is further increased by extension of fusion to the sacrum. Numerous techniques have been described for pelvic fixation associated with a long spine fusion each with its own set of specific benefits and risks. This article reviews the contemporary surgical techniques of pelvic fixation used to extend a spine fusion to the sacrum and pelvis focusing on the management of neuromuscular scoliosis, including their biomechanical rationale, results, and complications.

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P115. Low Profile Pelvic Fixation Anatomic Parameters for Sacral Alariliac Fixation vs. Traditional Iliac Fixation

Cited by 84 publications

References 0 publications

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability

Pelvic fixation for neuromuscular scoliosis deformity correction

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