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

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.

Minimally Invasive Sacroiliac Fixation for Extension of Fusion in Cases of Failed Lumbosacral Fusion

ABSTRACTSacroiliac fusion and instrumentation extension for correction of failed lumbosacral fusions traditionally requires a long revision surgery. Reopening of the prior surgical incision to expose the prior instrumentation requires a large incision with increased blood loss, increased operative time, increased risk of infection, and longer hospitalization times. We describe the first case series using a minimally invasive surgical sacroiliac screw technique for extension of a prior fusion to the pelvis. Using two small 3-cm paramedian incisions on each side, we were able to obtain autologous iliac crest bone graft, place the sacroiliac screw minimally invasive, perform an arthrodesis, and connect the prior surgical hardware to the sacroiliac screw safely. A detailed review of surgical technique, clinical cases, and brief review of the literature is discussed.