scholarly journals S2-Alar-Iliac Screw Fixation versus Iliac Screw Fixation in the Treatment of Sacral Fractures

2022 ◽  
pp. 1-7
Author(s):  
Yangxing Luo ◽  
Yue Li ◽  
Li He ◽  
Chengla Yi
Keyword(s):  
Screw Fixation ◽  
Sacral Fractures ◽  
Iliac Screw

A biomechanical investigation of the sacroiliac joint in the setting of lumbosacral fusion: impact of pelvic fixation versus sacroiliac joint fixation

2019 ◽  
Vol 31 (4) ◽  
pp. 562-567 ◽  
Author(s):  
Harry Mushlin ◽  
Daina M. Brooks ◽  
Joshua Olexa ◽  
Bryan J. Ferrick ◽  
Stephen Carbine ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Screw Fixation ◽  
Intact Specimen ◽  
Lumbosacral Fusion ◽  
Pelvic Fixation ◽  
Biomechanical Investigation ◽  
Flexion Extension ◽  
Iliac Screw ◽  
Sacroiliac Fusion ◽  
Bending Modes

OBJECTIVEThe sacroiliac joint (SIJ) is a known source of low-back pain. Randomized clinical trials support sacroiliac fusion over conservative management for SIJ dysfunction. Clinical studies suggest that SIJ degeneration occurs in the setting of lumbosacral fusions. However, there are few biomechanical studies to provide a good understanding of the effect of lumbosacral fusion on the SIJ. In the present study, researchers performed a biomechanical investigation to discern the effect of pelvic versus SIJ fixation on the SIJ in lumbosacral fusion.METHODSSeven fresh-frozen human cadaveric specimens were used. There was one intact specimen and six operative constructs: 1) posterior pedicle screws and rods from T10 to S1 (PS); 2) PS + bilateral iliac screw fixation (BIS); 3) PS + unilateral iliac screw fixation (UIS); 4) PS + UIS + 3 contralateral unilateral SIJ screws (UIS + 3SIJ); 5) PS + 3 unilateral SIJ screws (3SIJ); and 6) PS + 6 bilateral SIJ screws (6SIJ). A custom-built 6 degrees-of-freedom apparatus was used to simulate three bending modes: flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Range of motion (ROM) was recorded at L5–S1 and the SIJ.RESULTSAll six operative constructs had significantly reduced ROM at L5–S1 in all three bending modes compared to that of the intact specimen (p < 0.05). In the FE mode, the BIS construct had a significant reduction in L5–S1 ROM as compared to the other five constructs (p < 0.05). SIJ ROM was greatest in the FE mode compared to LB and AR. Although the FE mode did not show any statistically significant differences in SIJ ROM across the constructs, there were appreciable differences. The PS construct had the highest SIJ ROM. The BIS construct reduced bilateral SIJ ROM by 44% in comparison to the PS construct. The BIS and 6SIJ constructs showed reductions in SIJ ROM nearly equal to those of the PS construct. UIS and 3SIJ showed an appreciable reduction in unfused SIJ ROM compared to PS.CONCLUSIONSThis investigation demonstrated the effects of various fusion constructs using pelvic and sacroiliac fixation in lumbosacral fusion. This study adds biomechanical evidence of adjacent segment stress in the SIJ in fusion constructs extending to S1. Unilateral pelvic fixation, or SIJ fusion, led to an appreciable but nonsignificant reduction in the ROM of the unfused contralateral SIJ. Bilateral pelvic fixation showed the greatest significant reduction of movement at L5–S1 and was equivalent to bilateral sacroiliac fusion in reducing SIJ motion.

scholarly journals The technique of S2-alar-iliac screw fixation: a literature review

2017 ◽  
Vol 2 ◽  
pp. 179-179 ◽  
Author(s):  
Ai-Min Wu ◽  
◽  
Dong Chen ◽  
Chun-Hui Chen ◽  
Yu-Zhe Li ◽  
...  
Keyword(s):  
Literature Review ◽  
Screw Fixation ◽  
Iliac Screw

Palliative dual iliac screw fixation for lumbosacral metastasis

2007 ◽  
Vol 7 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Shunsuke Fujibayashi ◽  
Masashi Neo ◽  
Takashi Nakamura
Keyword(s):  
Screw Fixation ◽  
Spinal Metastases ◽  
Clinical Results ◽  
Spinal Fixation ◽  
Spinal Disease ◽  
Metastatic Lesions ◽  
Iliac Screw ◽  
Rod Breakage ◽  
Early Wound

✓ Spinal fixation for destructive metastatic lesions at the lumbosacral junction is challenging because of the large and unique load-bearing characteristics present. In particular, caudal fixation is difficult in cases of sacral destruction because of insufficient S-1 pedicle screw anchorage. The authors describe their surgical technique for secure iliac screw placement and the clinical results obtained in five patients with metastatic spinal disease. All patients in this study underwent palliative operations with dual iliac screw fixation between April 1999 and October 2002, and the clinical and radiological findings were assessed. In all five patients, spinal metastases extended into the sacrum. The metastases were from renal cell carcinomas in two patients, lung cancer in two, and a paraganglioma in one patient. Postoperative follow-up periods ranged from 3 months to 6 years (mean 28.4 months). Preoperatively, four patients could not walk due to severe pain or neurological compromise. Postoperatively, all patients reported a reduction in pain and regained the ability to walk. Complications included one case of early wound infection. In the patients with long survival after the operation, there was one case of iliac screw loosening and one case of rod breakage. The dual iliac screw fixation technique provided sufficient immediate stability for destructive lumbosacral metastasis.

scholarly journals Closed Reduction in a “Hyperextended Supine Position” with Percutaneous Transsacral-Transiliac and Iliosacral Screw Fixation for Denis Zone III Sacral Fractures

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Hideto Irifune ◽  
Suguru Hirayama ◽  
Nobuyuki Takahashi ◽  
Mitsumasa Chiba ◽  
Toshihiko Yamashita
Keyword(s):  
Supine Position ◽  
Closed Reduction ◽  
Screw Fixation ◽  
Clinical Results ◽  
Iliosacral Screw ◽  
Kyphotic Angle ◽  
Sacral Fractures ◽  
Neurological Outcomes ◽  
The Mean ◽  
Clinical And Radiological Results

Background. Herein, we demonstrate the clinical results of closed reduction in a hyperextended supine position with transsacral-transiliac (TSTI) and iliosacral (IS) screw fixations for Denis zone III sacral fractures. Patients and Methods. Sixteen consecutive patients with Denis zone III sacral fractures who were treated between January 2009 and September 2016 were evaluated. All patients were treated using percutaneous TSTI/IS screw fixation during closed reduction performed with patients placed in a hyperextended supine position with body manipulation. The clinical and radiological results were evaluated, and the neurological outcomes were retrospectively assessed using Gibbon’s classification system. The clinical outcomes were evaluated using the German Multicenter Study Group Pelvic Outcome Scale (POS). Results. The sacral kyphotic angle was reduced by 18.06° ± 15.26° (mean kyphotic angle: pre-OP, 39.44° ± 20.56°; post-OP, 21.38° ± 7.39°), and fracture translation was reduced by 5.93 ± 4.95 mm (mean fracture translation: pre-OP, 8.69 ± 8.03 mm; post-OP 2.75 ± 3.97 mm). The mean initial Gibbon’s score was 3.00 ± 1.32. Among 15 patients with a follow-up duration of over 12 months, the mean reduction loss in the sacral kyphotic angle was 5.87° ± 10.40° and was 1.00 ± 3.00 mm for the fracture translation. The final Gibbon’s score was 1.80 ± 1.21, and 73.3% of patients had good results based on the POS score. Conclusions. Although closed reduction in a hyperextended supine position with percutaneous posterior screw fixation is associated with some surgical limitations and technical difficulties, the procedure is minimally invasive and highly effective for stabilizing Denis zone III sacral fractures.

scholarly journals Usefulness of Sacral Sublaminar Wire for Low Transverse Sacral Fractures: Two Cases’ Report

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Tatsuro Sasaji ◽  
Hideki Imaizumi ◽  
Taishi Murakami
Keyword(s):  
Molecular Weight ◽  
Screw Fixation ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Sacral Fracture ◽  
Sacral Fractures ◽  
The Third ◽  
Ultrahigh Molecular Weight ◽  
Sacral Foramina ◽  
Bone Anchors ◽  
One Year

Low transverse sacral fractures are rare, with only two published reports regarding their surgery. The complication associated with surgery for sacral fractures is the prominence of implants. In addition, screw fixation below S3 is impractical. We performed posterior sacral fixation using S2 alar iliac (S2AI) screws and sacral sublaminar wires for low transverse sacral fractures. Case 1 was 65-year-old male with an S2-3 transverse sacral fracture. We performed laminectomy (S2-3) and passed ultrahigh molecular weight polyethylene (UHMWPE) cables from laminectomy area to the third posterior sacral foramina. We inserted S2AI screws and connected rods. We also tightened the UHMWPE cables. The implants did not protrude into skin. One year after surgery, the sacral fracture healed without any displacement. Case 2 was a 42-year-old female with an S2 transverse sacral fracture. We performed laminectomy (S1–3) and passed UHMWPE cables from laminectomy area to the third and fourth posterior sacral foramina. We inserted S1 pedicular screws and S2AI screws and connected rods. We also tightened UHMWPE cables. The implants did not protrude into skin. One year after surgery, the sacral fracture healed without any displacement. We consider sacral sublaminar wires to be useful bone anchors in lower sacrum.

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