Preliminary experience using S1–alar iliac fixation with navigation: technical note

2021 ◽  
Vol 35 (6) ◽  
pp. 774-779
Author(s):  
Bo Li ◽  
Andrew K. Chan ◽  
Praveen V. Mummaneni ◽  
John F. Burke ◽  
Michael M. Safaee ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Technical Note ◽  
Fixation Technique ◽  
Short Segment ◽  
Pelvic Fixation ◽  
Iliac Screws ◽  
Iliac Fixation ◽  
Term Data

Traditional iliac screws and S2–alar iliac (S2-AI) screws are common methods used for pelvic fixation, and many surgeons advocate pelvic fixation for long-segment fixation to the sacrum. However, in patients without severe deformities and only degenerative conditions, many surgeons may choose S1 screws only. Moreover, even with S2-AI screws, there is more muscular dissection than with using S1 screws, and the rod connection can be cumbersome in both S2-AI fixation and placing iliac screws. Using a surgical video, artist’s illustration, and intraoperative photographs, the authors describe the S1-AI screw fixation technique that allows for single-screw sacral and iliac fixation, requires less distal dissection of the sacrum, allows for easier rod connection, and may be an option in degenerative conditions needing pelvic fixation. However, this is a preliminary feasibility study, and in long fusion constructs, this type of fixation has only been used in conjunction with L5–S1 anterior lumbar interbody fusion (ALIF), and there are no long-term data on the use of this screw fixation technique without ALIF. In short-segment revision fusions, this technique may be considered for salvage in cases of large halos in the sacrum from loosened S1 screw fixation.

scholarly journals The Hardware Failure and Correction Loss of Short-segment Pedicle Screw Fixation Combined With Transforaminal Interbody Fusion in Treatment of Unstable Thoracolumbar Burst Fracture: Retrospective Study in Vietnam

2021 ◽  
Author(s):  
Ngoc Quyen Nguyen ◽  
Trong Hau Phan ◽  
Van Hong Vu
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Correction Loss ◽  
Short Segment ◽  
Hardware Failure ◽  
Transforaminal Interbody Fusion

Abstract Background: Correction loss and hardware failure of short segment posterior pedicle screw fixation in treatment of thoracolumbar unstable burst fracture have been remaining a main concern. Several authors have introduced the procedures to solve these limitations including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the progressive kyphosis and implant failure of short-segment pedicle screw fixation combined with transforaminal interbody fusion in treatment of unstable thoracolumbar burst fracture.Methods: The retrospective study were enrolled in the patients with isolated unstable thoracolumbar burst fractures, Denis type IIB who were treated by posterior short fixation with TIF between January 2013 to January 2017. Patients were followed up for a minimum of one and half year. For evaluation of correction loss, % loss of anterior vertebral body heights (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at final follow-up. The hardware failure was assessed on radiological images at last follow-up. Results: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and, RA were 10.2%, 2.9o and 5.6o, respectively. There were 6 patients (16.7%) with hardware failure at final follow-up. Conclusions: Short-segment posterior pedicle screw fixation with TIF using bone chip graft hasn’t prevented completely the hardware failure and progressive kyphosis in treatment of unstable thoracolumbar burst fracture.

Stereotactic navigation with the O-arm for placement of S-2 alar iliac screws in pelvic lumbar fixation

2013 ◽  
Vol 18 (5) ◽  
pp. 490-495 ◽  
Author(s):  
Wilson Z. Ray ◽  
Vijay M. Ravindra ◽  
Meic H. Schmidt ◽  
Andrew T. Dailey
Keyword(s):  
Sacroiliac Joint ◽  
Vascular Complications ◽  
Screw Placement ◽  
Computer Assisted ◽  
Long Term Outcome ◽  
Pelvic Fixation ◽  
Screw Length ◽  
Iliac Screws ◽  
Stereotactic Navigation ◽  
Iliac Fixation

Object Pelvic fixation is a crucial adjunct to many lumbar fusions to avoid L5–S1 pseudarthrosis. It is useful for treatment of kyphoscoliosis, high-grade spondylolisthesis, L5–S1 pseudarthrosis, sacral tumors, lumbosacral dislocations, and osteomyelitis. The most popular method, iliac fixation, has drawbacks including hardware prominence, extensive muscle dissection, and the need for connection devices. S-2 alar iliac fixation provides a useful primary or salvage alternative. The authors describe their techniques for using stereotactic navigation for screw placement. Methods The O-arm Surgical Imaging System allowed for CT-quality multiplanar reconstructions of the pelvis, and registration to a StealthStation Treon provided intraoperative guidance. The authors describe their technique for performing computer-assisted S-2 alar iliac fixation for various indications in 18 patients during an 18-month period. Results All patients underwent successful bilateral placement of screws 80–100 mm in length. All placements were confirmed with a second multiplanar reconstruction. One screw was moved because of apparent anterior breach of the ilium. There were no immediate neurological or vascular complications due to screw placement. The screw length required additional instruments including a longer pedicle finder and tap. Conclusions Stereotactic guidance to navigate the placement of distal pelvic fixation with bilateral S-2 alar iliac fixation can be safely performed in patients with a variety of pathological conditions. Crossing the sacroiliac joint, choosing trajectory, and ensuring adequate screw length can all be enhanced with 3D image guidance. Long-term outcome studies are underway, specifically evaluating the sacroiliac joint.

scholarly journals Comparative Study of Clinical Efficacy of Percutaneous Short Segment Pedicle Screw Fixation With or Without Screwing of the Fractured Vertebra With O-arm Navigation

2021 ◽  
Author(s):  
Xiaofeng Shao ◽  
Peng Peng ◽  
Peng Yang ◽  
Tian Xu ◽  
Zixiang Liu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Short Term ◽  
Short Segment ◽  
Term Efficacy ◽  
Significant Difference ◽  
One Year

Abstract Objective: To retrospectively analyze the short-term and long-term efficacy of O-arm-navigated percutaneous short segment pedicle screw fixation with or without screwing of the fractured vertebra.Methods: 42 patients who underwent O-arm-navigated percutaneous short segment pedicle screw fixation for the treatment of thoracolumbar fractures from February 2015 to December 2018 were selected. The patients were divided into two groups according to fixation with or without screwing of the fractured vertebra, 21 cases each. The operation time, length of incision and intraoperative bleeding of the two groups of patients, as well as preoperative, one-week postoperatively and one-year postoperatively Cobb angle, percentage of anterior vertebral height, VAS and ODI data were analyzed to compare the short-term and long-term clinical outcomes of the two groups.Results: All the patients underwent surgery successfully. There were no neurological or other complications after the surgery. All patients were followed up for at least one year. There was no failure of fixation at the one-year follow-up. There was no significant difference in the operation time and intraoperative blood loss between the two groups (P>0.05). The length of incision was statistically significantly different between the two groups (P<0.05). There was no significant difference in Cobb angle and AVH% between the two groups before and one week after the surgery (P>0.05). The Cobb angle and AVH% was statistically significantly different one year after the surgery between the two groups (P<0.05).The Cobb angle and AVH% contrast was statistically significant before surgery, one week and one year after the surgery in the respective group (P<0.05). There was no statistically significant difference in the VAS and ODI preoperatively, one-week and one-year postoperatively between the two groups (P>0.05). There was statistically significant difference in the VAS and ODI throughout the follow-up period in the respective group(P<0.05). Conclusion: The short-term efficacy of the two groups is similar, but the long-term efficacy is better through screwing of the fractured vertebra.

scholarly journals Strategy for obtaining solid fusion at L5–S1 in adult spinal deformity: risk factor analysis for nonunion at L5–S1

2020 ◽  
Vol 33 (3) ◽  
pp. 323-331 ◽  
Author(s):  
Ki Young Lee ◽  
Jung-Hee Lee ◽  
Kyung-Chung Kang ◽  
Sung Joon Shin ◽  
Won Ju Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Spinal Deformity ◽  
Sagittal Balance ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Ct Scans ◽  
Iliac Screws ◽  
Iliac Fixation

OBJECTIVEMaintaining lumbosacral (LS) arthrodesis and global sagittal balance after long fusion to the sacrum remains an important issue in the surgical treatment for adult spinal deformity (ASD). The importance and usefulness of LS fixation have been documented, but the optimal surgical long fusion to the sacrum remains a matter for debate. Therefore, the authors performed a retrospective study to evaluate fusion on CT scans and the risk factors for LS pseudarthrosis (nonunion) after long fusion to the sacrum in ASD.METHODSThe authors performed a retrospective study of 59 patients with lumbar degenerative kyphosis (mean age 69.6 years) who underwent surgical correction, including an interbody fusion of the L5–S1, with a minimum 2-year follow-up. Achievement of LS fusion was evaluated by analyzing 3D-CT scans at 3 months, 6 months, 9 months, 1 year, and 2 years after surgery. Patients were classified into a union group (n = 36) and nonunion group (n = 23). Risk factors for nonunion were analyzed, including patient and surgical factors.RESULTSThe overall fusion rate was 61% (36/59). Regarding radiological factors, optimal sagittal balance at the final follow-up significantly differed between two groups. There were no significant differences in terms of patient factors, and no significant differences with respect to the use of pedicle subtraction osteotomy, the number of fused segments, the proportion of anterior versus posterior interbody fusion, S2 alar iliac fixation versus conventional iliac fixation, or loosening of sacral or iliac screws. However, the proportion of metal cages to polyetheretherketone cages and the proportion of sacropelvic fixation were significantly higher in the union group (p = 0.022 and p < 0.05, respectively).CONCLUSIONSLS junction fusion is crucial for global sagittal balance, and the use of iliac screws in addition to LS interbody fusion using a metal cage improves the outcomes of long fusion surgery for ASD patients.

scholarly journals Peculiarities of spinopelvic fixation in deformations and traumatic injuries of the spine

2021 ◽  
Vol 28 (1) ◽  
pp. 17-27
Author(s):  
Marchel S. Vetrile ◽  
Alexander A. Kuleshov ◽  
Sergey N. Makarov ◽  
Igor N. Lisyansky ◽  
Alexey I. Kokorev ◽  
...  
Keyword(s):  
Repeated Treatment ◽  
Stable Fixation ◽  
Optimal Method ◽  
Traumatic Injuries ◽  
Pelvic Fixation ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Long Term Follow Up

AIM: to evaluate the effectiveness of spinal pelvic fixation with screws inserted through the S2 vertebra into the ilium (S2AIS technique) and the use of individual pelvic support plates. METHODS. The analysis of the results of performing spinal-pelvic fixation in 74 patients with various pathologies of spine column and traumatic injuries (66 patients S2AIS technique, 8 patients fixation with individually made implants) was carried out. RESULTS. The long-term follow-up period for the patient averaged 23.5 months (from 6 to 48 months). In the group of patients with fixation using the S2AIS method, the absence of complications, requiring repeated treatment, and stable fixation in the long-term follow-up period was noted in 53 cases (78.7%). The overall incidence of malpositions out of the total number of screws established was 4.3%; only one case (0.7%) required reoperation. Fracture of the metal implant rod at the L5-S1 level (15.2%), fracture of the screws in the ilium (5%) and instability of fixation with resorption of bone tissue around the screws in the S1 vertebra and in the ilium (3%). With fixation using individual support plates, stable fixation of spinopelvic fixation in the long-term period was achieved in 5 cases; in three cases, the implants had to be removed. CONCLUSION. Installation of iliac screws using the S2AIS technique is the optimal method of spinopelvic fixation, allowing reliable fixation with minimal complications. In cases where traditional methods of spinopelvic fixation are impossible or technically difficult, fixation with customized implants is possible.

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

2013 ◽  
Vol 19 (3) ◽  
pp. 321-330 ◽  
Author(s):  
Tobias A. Mattei ◽  
Daniel R. Fassett
Keyword(s):  
Revision Surgery ◽  
Retrospective Review ◽  
Technical Note ◽  
Imaging Findings ◽  
Degenerative Scoliosis ◽  
Pelvic Fixation ◽  
Surgical Case ◽  
Adult Degenerative Scoliosis ◽  
Iliac Screws ◽  
Interesting Alternative

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.

Sign in / Sign up

Export Citation Format

Share Document