Clinical application of individualized S<sub>1</sub> pedicle screw placement_West China Medical Journal

Authors：

WAN Shengyu ,  LIN Xu , ZHANG Jian , ZENG Yulin , WU Fan , WU Chao , ZHONG Zeli , ZENG Jun , DENG Jiayan , TAN Lun

Section I, Department of Orthopaedics, the Fourth People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

LIN Xu, Email: med_linxu@163.com

Keywords：

Sacral; Individual; Pedicle screw; Biomechanical

DOI：

10.7507/1002-0179.201907228

Video：

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Objective To explore the feasibility of the clinical application of individualized simulated S₁ pedicle screw.Methods The data of patients with lumbar disease diagnosed and treated in the Fourth People’s Hospital of Zigong from May 2017 to April 2019 were retrospectively analyzed. According to the preoperative individualized design of the S₁ pedicle screw placement path, the patients were divided into individualized screw placement group and traditional screw placement group. The distance D between the screw tip and the endplate of the S₁, the angle α of the screw in the plane of the dysplasia and the lumbar pedicle of the L₅, the angle of oblique angle β, the number of screws of 35 and 40 mm in length, and the screw loosening rate (followed-up within 1 year) in the two groups were analyzed.Results A total of 59 patients were enrolled in this study, 31 in the individualized screw placement group and 28 in the traditional screw placement group. The differences in the distance D between the screw tip and the endplate of the S₁ [(2.61±0.82) vs.(4.13±1.51) mm; t=-5.718, P<0.001], the angle α of the screw in the plane of the dysplasia and the lumbar pedicle of the L₅ [(9.31±3.52) vs. (13.53±4.78)°; t=-5.646, P<0.001], the angle of oblique angle β [(15.73±6.04) vs. (10.65±5.09)°; t=3.022, P=0.004], the proportion of using screw models [40 mm in length: 56 vs. 8; 35 mm in length: 6 vs. 48; χ²=68.539, P<0.001], and the screw loosening rate followed-up within 1 year [3.22% vs. 16.07%; χ²=5.774, P<0.001] were statistically significant between the individualized screw placement group and the traditional screw placement group.Conclusions Preoperative individualized design of the pedicle screw of the S₁ pedicle screw can be used in clinical practice. The biomechanical stability of the S₁ pedicle screw can be improved and the sagittal balance can be achieved.

Citation： WAN Shengyu, LIN Xu, ZHANG Jian, ZENG Yulin, WU Fan, WU Chao, ZHONG Zeli, ZENG Jun, DENG Jiayan, TAN Lun. Clinical application of individualized S₁ pedicle screw placement. West China Medical Journal, 2019, 34(9): 980-985. doi: 10.7507/1002-0179.201907228 Copy

1.	Lehman RA Jr, Kuklo TR, Belmont PJ Jr, et al. Advantage of pedicle screw fixation directed into the apex of the sacral promontory over bicortical fixation: a biomechanical analysis. Spine (Phila Pa 1976), 2002, 27(8): 806-811.
2.	Galbusera F, Volkheimer D, Reitmaier S, et al. Pedicle screw loosening: a clinically relevant complication?. Eur Spine J, 2015, 24(5): 1005-1016.
3.	Paxinos O, Tsitsopoulos PP, Zindrick MR, et al. Evaluation of pullout strength and failure mechanism of posterior instrumentation in nomal and osteopenic thoracic venebrae. J Neurosurg Spine, 2010, 13(4): 469-476.
4.	Krishnan V, Varghese V, Kumar GS, et al. Comparative analysis of effect of density, insertion angle and reinsertion on pull-out strength of single and two pedicle screw constructs using synthetic bone model. Asian Spine J, 2016, 10(3): 414-421.
5.	Zhuang XM, Fu CF, liu WG, et al. Biomechanical effect of the correction on the anchoring strength of de-orbiting S1 bicorticaI pedicle screw- an in-vitro investigation in normal and osteoporotic conditions. Clin Biomech (Bristol, Avon), 2016, 36: 26-31.
6.	Varghese V, Saravana Kumar G, Krishnan V, et al. Effect of various factors on pull out strength of pedicle screw in normal and osteoporotic cancellous bone models. Med Eng Phys, 2017, 40: 28-38.
7.	王春生, 苏峰, 张春玲, 等. 不同骨密度对胸腰椎椎弓根内固定早期稳定性的生物力学研究. 中国骨质疏松杂志, 2016, 22(1): 36-40.
8.	Zheng Y, Lu WW, Zhu Q, et al. Variation in bone mineral density of the sacrum in young adults and its significance for sacral fixation. Spine (Phila Pa 1976), 2000, 25(3): 353-357.
9.	Hadjipavlou AG, Nicodemus CL, al-Hamdan FA, et al. Correlation of bone equivalent mineral density to pull-out resistance of triangulated pedicle screw construct. J Spinal Disord, 1997, 10(1): 12-19.
10.	Pfeiffer M, Hoffman H, Goel VK, et al. In vitro testing of a new transpedicular stabilization technique. Eur Spine J, 1997, 6(4): 249-255.
11.	Matsukawa K, Yato Y, Kato T, et al. Cortical bone trajectory for lumbosacral fixation: penetrating S-1 endplate screw technique: technical note. J Neurosurg Spine, 2014, 21(2): 203-209.
12.	Krag MH, Beynnon BD, Pope MH, et al. An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing. Clin Orthop Relat Res, 1986(203): 75-98.
13.	陈群, 金正帅, 曹晓健, 等. 不同外倾角的脊柱椎弓根螺钉内固定效果的生物力学评价. 河北医学, 2005, 11(5): 433-435.
14.	彭自强. 寰椎单节横向加压内固定系统的设计制作及生物力学分析. 南宁: 广西医科大学, 2016: 1-152.
15.	万盛钰, 林旭, 吴超, 等. 基于三维重建模拟S1椎弓根螺钉的最佳置钉参数. 中国组织工程研究, 2018, 22(35): 5620-5624.
16.	Krag MH, Beynnon BD, Pope MH, et al. Depth of insertion of transpedicular vertebral screws into human vertebrae: effect upon screw-vertebra interface strength. J Spinal Disord, 1988, 1(4): 287-294.
17.	McKinley TO, McLain RF, Yerby SA, et al. Characteristics of pedicle screw loading. Effect of surgical technique on intravertebral and intrapedicular bending moments. Spine (Phila Pa 1976), 1999, 24(1): 18-24.
18.	朱敦延, 张志. 短节段椎弓根螺钉内固定术后断裂原因探讨. 中国矫形外科杂志, 2002, 9(5): 506-507.
19.	Röllinghoff M, Schlüter-Brust K, Groos D, et al. Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine. Orthop Rev (Pavia), 2010, 2(1): e3.
20.	Kim JB, Park SW, Lee YS, et al. The effects of spinopelvie parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc, 2015, 58(4): 357-362.
21.	Bredow J, Boese CK, Werner CM, et al. Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg, 2016, 136(8): 1063-1067.
22.	Gazzeri R, Roperto R, Fiore C. Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study. J Neurosurg Spine, 2016, 25(5): 610-619.
23.	Wu ZX, Gong FT, Liu L, et al. A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws. Arch Orthop Trauma Surg, 2012, 132(4): 471-476.

1. Lehman RA Jr, Kuklo TR, Belmont PJ Jr, et al. Advantage of pedicle screw fixation directed into the apex of the sacral promontory over bicortical fixation: a biomechanical analysis. Spine (Phila Pa 1976), 2002, 27(8): 806-811.
2. Galbusera F, Volkheimer D, Reitmaier S, et al. Pedicle screw loosening: a clinically relevant complication?. Eur Spine J, 2015, 24(5): 1005-1016.
3. Paxinos O, Tsitsopoulos PP, Zindrick MR, et al. Evaluation of pullout strength and failure mechanism of posterior instrumentation in nomal and osteopenic thoracic venebrae. J Neurosurg Spine, 2010, 13(4): 469-476.
4. Krishnan V, Varghese V, Kumar GS, et al. Comparative analysis of effect of density, insertion angle and reinsertion on pull-out strength of single and two pedicle screw constructs using synthetic bone model. Asian Spine J, 2016, 10(3): 414-421.
5. Zhuang XM, Fu CF, liu WG, et al. Biomechanical effect of the correction on the anchoring strength of de-orbiting S1 bicorticaI pedicle screw- an in-vitro investigation in normal and osteoporotic conditions. Clin Biomech (Bristol, Avon), 2016, 36: 26-31.
6. Varghese V, Saravana Kumar G, Krishnan V, et al. Effect of various factors on pull out strength of pedicle screw in normal and osteoporotic cancellous bone models. Med Eng Phys, 2017, 40: 28-38.
7. 王春生, 苏峰, 张春玲, 等. 不同骨密度对胸腰椎椎弓根内固定早期稳定性的生物力学研究. 中国骨质疏松杂志, 2016, 22(1): 36-40.
8. Zheng Y, Lu WW, Zhu Q, et al. Variation in bone mineral density of the sacrum in young adults and its significance for sacral fixation. Spine (Phila Pa 1976), 2000, 25(3): 353-357.
9. Hadjipavlou AG, Nicodemus CL, al-Hamdan FA, et al. Correlation of bone equivalent mineral density to pull-out resistance of triangulated pedicle screw construct. J Spinal Disord, 1997, 10(1): 12-19.
10. Pfeiffer M, Hoffman H, Goel VK, et al. In vitro testing of a new transpedicular stabilization technique. Eur Spine J, 1997, 6(4): 249-255.
11. Matsukawa K, Yato Y, Kato T, et al. Cortical bone trajectory for lumbosacral fixation: penetrating S-1 endplate screw technique: technical note. J Neurosurg Spine, 2014, 21(2): 203-209.
12. Krag MH, Beynnon BD, Pope MH, et al. An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing. Clin Orthop Relat Res, 1986(203): 75-98.
13. 陈群, 金正帅, 曹晓健, 等. 不同外倾角的脊柱椎弓根螺钉内固定效果的生物力学评价. 河北医学, 2005, 11(5): 433-435.
14. 彭自强. 寰椎单节横向加压内固定系统的设计制作及生物力学分析. 南宁: 广西医科大学, 2016: 1-152.
15. 万盛钰, 林旭, 吴超, 等. 基于三维重建模拟S1椎弓根螺钉的最佳置钉参数. 中国组织工程研究, 2018, 22(35): 5620-5624.
16. Krag MH, Beynnon BD, Pope MH, et al. Depth of insertion of transpedicular vertebral screws into human vertebrae: effect upon screw-vertebra interface strength. J Spinal Disord, 1988, 1(4): 287-294.
17. McKinley TO, McLain RF, Yerby SA, et al. Characteristics of pedicle screw loading. Effect of surgical technique on intravertebral and intrapedicular bending moments. Spine (Phila Pa 1976), 1999, 24(1): 18-24.
18. 朱敦延, 张志. 短节段椎弓根螺钉内固定术后断裂原因探讨. 中国矫形外科杂志, 2002, 9(5): 506-507.
19. Röllinghoff M, Schlüter-Brust K, Groos D, et al. Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine. Orthop Rev (Pavia), 2010, 2(1): e3.
20. Kim JB, Park SW, Lee YS, et al. The effects of spinopelvie parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc, 2015, 58(4): 357-362.
21. Bredow J, Boese CK, Werner CM, et al. Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg, 2016, 136(8): 1063-1067.
22. Gazzeri R, Roperto R, Fiore C. Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study. J Neurosurg Spine, 2016, 25(5): 610-619.
23. Wu ZX, Gong FT, Liu L, et al. A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws. Arch Orthop Trauma Surg, 2012, 132(4): 471-476.

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Clinical application of individualized S₁ pedicle screw placement

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West China Medical Journal

Clinical application of individualized S1 pedicle screw placement

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Clinical application of individualized S₁ pedicle screw placement