Unilateral and Bilateral Sacropelvic Fixation Result in Similar Construct Biomechanics

Tomlinson, Tucker; Chen, Jack; Upasani, Vidyadhar V.; Mahar, Andrew

doi:10.1097/brs.0b013e31817bd8d5

Cited by 16 publications

(10 citation statements)

References 22 publications

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“…However, Harrington rod fixation utilized limited fixation points and this fact, combined with the use of distraction for correction of deformities resulted in a high incidence of flatback deformities and loss of lumbar lordosis. Kostuik et al [8] reported a rate of pseudarthrosis and flatback deformities as high as 40 and 50 %, respectively, in their series of 48 adult scoliotic patients who underwent fusion to the sacrum. Similarly, in 1986 Balderston et al [5] reported on their experience with a nonparalytic adult scoliosis patients and noted that 37 % of their patients developed a flatback deformity.…”

Section: Historymentioning

confidence: 99%

“…8 Postoperative a AP and b lateral 36-inch standing radiographs with four-rod technique demonstrating restoration of coronal and sagittal alignment. Notice that 4 pelvic screws were cement augmented to increase purchase within the ilium proximal screws and still allows for a deeply buried screw head [40]. The rod should be placed first into the iliac screw and then into the S1 screw head.…”

Section: S1/iliac Screw Alignment Techniquementioning

confidence: 99%

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Pelvic fixation for adult scoliosis

et al. 2012

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There is growing evidence that pelvic fixation may become the standard for obtaining long fusions in adult scoliosis. Although technically challenging, in selected cases the use of four pelvic screws and/or four rods across the lumbosacral pelvis can help address pseudarthroses, implant breakage, and screw pullout secondary to osteoporosis. Ultimately, indications and techniques should be individualized to the patient and based on surgeon preference and experience.

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Section: Historymentioning

confidence: 99%

Section: S1/iliac Screw Alignment Techniquementioning

confidence: 99%

Pelvic fixation for adult scoliosis

et al. 2012

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“…6,[8][9][10] However, more recent biomechanical studies have indicated that unilateral and bilateral iliac screw fixation provide comparable construct biomechanics, that is, construct stiffness and lumbosacral range of motion. 13 Some studies have even suggested that unilateral iliac screw fixation provides better clinical outcomes (for example, improved sagittal balance and reduced distal implant complications) than bilateral screw fixation.…”

Section: 14mentioning

confidence: 99%

“…13 Today, most spine deformity surgeons incorporate iliac screw fixation in fusion constructs extending from L-2 or higher to the sacrum, but the decision to place iliac screws unilaterally or bilaterally remains multifactorial and is often determined by surgeon preference.…”

mentioning

confidence: 99%

Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

Saigal¹,

Lau²,

Wadhwa³

et al. 2014

FOC

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Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

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“…Such scenarios are encountered in the management of high-grade spondylolisthesis, complex deformities, sacral fractures, and post-sacrectomy reconstructions. Despite advances in techniques and implants, technical limitations, fixation complications and hardware failures continue to present clinical challenges following complex spinopelvic reconstructions [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

The posterior superior iliac rim screw as an adjunct to pelvic fixation in complex spinopelvic stabilization

Joo

Grauer

2021

North American Spine Society Journal (NASSJ)

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Background Fixation to the ilium is a commonly used alternative or supplement to sacral fixation in complex spinopelvic reconstructions. This can be achieved with traditional posterior superior iliac spine or S2 alar-iliac screws. Posterior superior iliac rim screws may be considered to achieve or enhance pelvic fixation. The objective of this case series was to describe the use of and indications for posterior superior iliac rim screws. Methods A retrospective review was performed of the medical records and radiographic data for three patients who underwent complex lumbosacral reconstructions involving the use of posterior superior iliac rim screws to enhance pelvic fixation. The cases included a 35-year-old with bilateral sacral fractures, a 43-year-old with extensive metastatic sarcoma to the sacrum, and a 48-year-old with multiple lumbar and pelvic fractures. An overview of the key surgical techniques is provided. Results All three patients tolerated the procedure, without any unexpected post-operative complications or deficits. Radiographs at last follow-up showed stable fixation and no hardware issues. Conclusions The use of posterior superior iliac rim screws as an adjunct method of fixation in complex spinopelvic reconstructions is a feasible option that can be considered in the fixation armamentarium.

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Unilateral and Bilateral Sacropelvic Fixation Result in Similar Construct Biomechanics

Cited by 16 publications

References 22 publications

Pelvic fixation for adult scoliosis

Pelvic fixation for adult scoliosis

Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

The posterior superior iliac rim screw as an adjunct to pelvic fixation in complex spinopelvic stabilization

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