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Modified iliac screw fixation: technique and clinical application

  • Clinical Article - Spine
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Abstract

Background

A conventional iliac bolt and the S2 alar iliac screw fixation technique (S2AI) are commonly used sacropelvic fixation techniques. However, conventional iliac bolt technique requires a lateral connector and commonly has prominent screw head problems. S2AI reportedly has a high instrument failure rate. We aim to introduce a modified iliac screw fixation technique and to investigate its clinical application in adult patients.

Methods

The entrance site of the modified iliac screw fixation technique was 1 cm medial and 1 cm caudal from the posterosuperior iliac spine. From 2009 to 2015, ten adult patients underwent sacropelvic fixation with the modified iliac screw fixation technique in our spine clinic. A minimum 12-month clinical and radiographic follow-up was adopted. The mean follow-up period was 30.7 months (12–74 months). Mean number of fixation levels was 7.7 segments (5–10 segments).

Results

Postoperatively, the C7 plumb line (SVA) was significantly decreased (P = 0.04). Upon the last X-ray, SVA did not differ between postoperative and the last X-ray (P = 0.1). There was no breakage during our follow-up period. There was no prominent screw head. There were no cases requiring implant removal.

Conclusions

The modified iliac screw fixation technique does not cause prominence in the sacral region, and does not require a lateral connector, both of which are necessary when using the classical iliac bolt technique. This technique also avoids the acute angle between the screw head and the shaft of the screw commonly seen in S2AI. The modified iliac screw fixation technique can be an effective alternative for sacropelvic fixation.

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References

  1. Choi I, Jeon SR (2014) The result of S1 double screw fixation in patients not suited for L4 and/or L5 pedicle screw insertion. Acta Neurochir (Wien) 156:229–233

    Article  Google Scholar 

  2. Devlin VJ, Boachie-Adjei O, Bradford DS, Ogilvie JW, Transfeldt EE (1991) Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation. J Spinal Disord 4:1–14

    Article  CAS  PubMed  Google Scholar 

  3. Dubory A, Bachy M, Bouloussa H, Courvoisier A, Morel B, Vialle R (2015) Screw augmentation for spinopelvic fixation in neuromuscular spine deformities: technical note. Eur Spine J 24:2580–2587

    Article  PubMed  Google Scholar 

  4. Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976) 27:776–786

    Article  Google Scholar 

  5. Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465

    Article  Google Scholar 

  6. Grechenig S, Gansslen A, Gueorguiev B, Berner A, Muller M, Nerlich M, Schmitz P (2015) PMMA-augmented SI screw: a biomechanical analysis of stiffness and pull-out force in a matched paired human cadaveric model. Injury 46(Suppl 4):S125–S128

    Article  PubMed  Google Scholar 

  7. Guler UO, Cetin E, Yaman O, Pellise F, Casademut AV, Sabat MD, Alanay A, Grueso FS, Acaroglu E, European Spine Study G (2015) Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J 24:1085–1091

    Article  PubMed  Google Scholar 

  8. Kebaish KM (2010) Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976) 35:2245–2251

    Article  Google Scholar 

  9. Koller H, Zenner J, Hempfing A, Ferraris L, Meier O (2013) Reinforcement of lumbosacral instrumentation using S1-pedicle screws combined with S2-alar screws. Oper Orthop Traumatol 25:294–314

    Article  CAS  PubMed  Google Scholar 

  10. Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG (2001) Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:1976–1983

    Article  CAS  Google Scholar 

  11. Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, Boachie-Adjei O, Wagner TA (2002) Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine (Phila Pa 1976) 27:2312–2320

    Article  Google Scholar 

  12. Moshirfar A, Rand FF, Sponseller PD, Parazin SJ, Khanna AJ, Kebaish KM, Stinson JT, Riley LH 3rd (2005) Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am 87(Suppl 2):89–106

    Article  PubMed  Google Scholar 

  13. Oberkircher L, Masaeli A, Bliemel C, Debus F, Ruchholtz S, Kruger A (2015) Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens-a biomechanical investigation. Spine J 16(2):226–232

    Article  PubMed  Google Scholar 

  14. Saer EH 3rd, Winter RB, Lonstein JE (1990) Long scoliosis fusion to the sacrum in adults with nonparalytic scoliosis: an improved method. Spine (Phila Pa 1976) 15:650–653

    Article  Google Scholar 

  15. Schwend RM, Sluyters R, Najdzionek J (2003) The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976) 28:542–547

    Google Scholar 

  16. Shen FH, Mason JR, Shimer AL, Arlet VM (2013) Pelvic fixation for adult scoliosis. Eur Spine J 22(Suppl 2):S265–S275

    Article  PubMed  Google Scholar 

  17. Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C (2006) Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976) 31:303–308

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea

    Seil Sohn, Chun Kee Chung, Chi Heon Kim, Sung Bae Park & Hyejin Kim

  2. Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea

    Seil Sohn, Chun Kee Chung, Chi Heon Kim & Hyejin Kim

  3. Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea

    Seil Sohn, Chun Kee Chung, Chi Heon Kim & Hyejin Kim

  4. Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, South Korea

    Seil Sohn

  5. Department of Orthopedics, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Yongjung Jay Kim

  6. Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea

    Sung Bae Park

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  1. Seil Sohn
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  2. Chun Kee Chung
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Correspondence to Chun Kee Chung.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type study, formal consent is not required. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Funding

The Ministry of Science, ICT and Future Planning provided financial support in the form of the Basic Science Research Program through the National Research Foundation of Korea (NRF) (2014R1A2A1A11049662). The sponsor had no role in the design or conduct of this research.

Disclosure

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

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Sohn, S., Chung, C.K., Kim, Y.J. et al. Modified iliac screw fixation: technique and clinical application. Acta Neurochir 158, 975–980 (2016). https://doi.org/10.1007/s00701-016-2772-x

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  • DOI: https://doi.org/10.1007/s00701-016-2772-x

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