Application of second sacral alar-iliac screw technique for reconstruction of spinopelvic stability_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Nanwei ^1,2 ,  YU Binsheng ^2,3

1. Shantou University Medical College, Shantou Guangdong, 515041, P.R.China;
2. Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518036, P.R.China;
3. Shenzhen Key Laboratory of Spine Surgery, Orthopaedic Research Center, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518036, P.R.China;

Corresponding author：

YU Binsheng, Email: hpyubinsheng@hotmail.com

Keywords：

Second sacral alar-iliac screw; reconstruction of spinopelvic stability; internal fixation; iliac screw

DOI：

10.7507/1002-1892.201711124

Video：

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Objective To summarize the current research progress of second sacral alar-iliac (S₂AI) screw technique for reconstruction of spinopelvic stability. Methods The recent original literature concerning development, clinical applications, anatomy, imageology, and biomechanics of S₂AI screw technique in reconstruction of spinopelvic stability was reviewed and analyzed. Results As a common clinical strategy for the reconstruction of spinopelvic stability, S₂AI screws achieve satisfactory effectiveness of lumbosacral fixation without complications which were found during the application of traditional iliac screws technique. S₂AI screw technique is more difficult to place screws by hand because of its narrow screw trajectory. Although the S₂AI screws trajectory pass through 3 layers of bone cortex, the biomechanical cadaveric study demonstrate that no statistical difference in stiffness was found between the traditional iliac and S₂AI screw in a spinopelvic fixation model. Conclusion S₂AI screw technique should be a safe and feasible method for reconstruction of spinopelvic stability in place of the traditional iliac screw technique.

Citation： ZHANG Nanwei, YU Binsheng. Application of second sacral alar-iliac screw technique for reconstruction of spinopelvic stability. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 764-768. doi: 10.7507/1002-1892.201711124 Copy

1.	Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg (Am), 2006, 88(4): 721-728.
2.	Bridwell KH, Edwards CC 2nd, Lenke LG. The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct. Spine (Phila Pa 1976), 2003, 28(20): S234-242.
3.	Emami A, Deviren V, Berven S, et al. 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), 2002, 27(7): 776-786.
4.	Chang TL, Sponseller PD, Kebaish KM, et al. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976), 2009, 34(5): 436-440.
5.	Yoshihara H. Rods in spinal surgery: a review of the literature. Spine J, 2013, 13(10): 1350-1358.
6.	Jain A, Hassanzadeh H, Strike SA, et al. Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone Joint Surg (Am), 2015, 97(18): 1521-1528.
7.	Shen FH, Mason JR, Shimer AL, et al. Pelvic fixation for adult scoliosis. Eur Spine J, 2013, 22 Suppl 2: S265-275.
8.	Tis JE, Helgeson M, Lehman RA, et al. A biomechanical comparison of different types of lumbopelvic fixation. Spine (Phila Pa 1976), 2009, 34(24): E866-872.
9.	Tumialán LM, Mummaneni PV. Long-segment spinal fixation using pelvic screws. Neurosurgery, 2008, 63(3 Suppl): 183-190.
10.	Tsuchiya K, Bridwell KH, Kuklo TR, et al. Minimum 5-year analysis of L₅-S₁ fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976), 2006, 31(3): 303-308.
11.	O’Brien JR, Yu WD, Bhatnagar R, et al. An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976), 2009, 34(12): E439-442.
12.	Zhu F, Bao HD, Yuan S, et al. Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population. Eur Spine J, 2013, 22(7): 1683-1689.
13.	Wu AM, Chi YL, Ni WF, et al. The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study. PeerJ, 2016, 4: e1587.
14.	Sponseller PD, Zimmerman RM, Ko PS, et al. Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine (Phila Pa 1976), 2010, 35(20): 1887-1892.
15.	刘臻, 邱勇, 胡宗杉, 等. 经第 2 骶椎骶髂螺钉固定技术在成人脊柱侧后凸畸形中的应用. 中华骨科杂志, 2016, 36(10): 584-590.
16.	Park YS, Hyun SJ, Park JH, et al. Radiographic and clinical results of freehand S₂ alar-iliac screw placement for spinopelvic fixation: an analysis of 45 consecutive screws. Clin Spine Surg, 2017, 30(7): E877-E882.
17.	Mazur MD, Mahan MA, Shah LM, et al. Fate of S₂-alar-iliac screws after 12-month minimum radiographic follow-up: preliminary results. Neurosurgery, 2017, 80(1): 67-72.
18.	Ilyas H, Place H, Puryear A. A comparison of early clinical and radiographic complications of iliac screw fixation versus S₂ alar iliac (S2AI) fixation in the adult and pediatric populations. J Spinal Disord Tech, 2015, 28(4): E199-205.
19.	Mazur MD, Ravindra VM, Schmidt MH, et al. Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine, 2015, 23(1): 67-76.
20.	Elder BD, Ishida W, Lo SL, et al. Use of S₂-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine (Phila Pa 1976), 2017, 42(3): E142-E149..
21.	Ishida W, Elder BD, Holmes C, et al. Comparison between S₂-alar-iliac screw fixation and iliac screw fixation in adult deformity surgery: reoperation rates and spinopelvic parameters. Global Spine J, 2017, 7(7): 672-680.
22.	Lattig F, Weckbach S. S₂-alar-iliac screws for extended pelvic fixation in longer lumbar instrumentations: Description of a freehand technique. Oper Orthop Traumatol, 2017, 29(4): 360-372.
23.	王孝宾, 王冰, 李晶, 等. 经骶 2 髂骨螺钉内固定在腰骶段结核稳定性重建中的应用. 中国脊柱脊髓杂志, 2017, 27(5): 392-398.
24.	Funao H, Kebaish KM, Isogai N, et al. Utilization of a technique of percutaneous S₂ alar-iliac fixation in immunocompromised patients with spondylodiscitis. World Neurosurg, 2017, 97: 757.e11-757.e18.
25.	O’Brien JR, Matteini L, Yu WD, et al. Feasibility of minimally invasive sacropelvic fixation: percutaneous S₂ alar iliac fixation. Spine (Phila Pa 1976), 2010, 35(4): 460-464.
26.	Martin CT, Witham TF, Kebaish KM. Sacropelvic fixation: two case reports of a new percutaneous technique. Spine (Phila Pa 1976), 2011, 36(9): E618-621.
27.	Nottmeier EW, Pirris SM, Balseiro S, et al. Three-dimensional image-guided placement of S2 alar screws to adjunct or salvage lumbosacral fixation. Spine J, 2010, 10(7): 595-601.
28.	O’Brien JR, Yu W, Kaufman BE, et al. Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation. Spine (Phila Pa 1976), 2013, 38(20): E1250-1255.
29.	Burns CB, Dua K, Trasolini NA, et al. Biomechanical comparison of spinopelvic fixation constructs: iliac screw versus S₂-alar-iliac screw. Spine Deform, 2016, 4(1): 10-15.
30.	Sutterlin CE 3rd, Field A, Ferrara LA, et al. Range of motion, sacral screw and rod strain in long posterior spinal constructs: a biomechanical comparison between S2 alar iliac screws with traditional fixation strategies. J Spine Surg, 2016, 2(4): 266-276.
31.	Hoernschemeyer DG, Pashuck TD, Pfeiffer FM. Analysis of the s2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine? Spine J, 2017, 17(6): 875-879.
32.	Ishida W, Elder BD, Holmes C, et al. S₂-alar-iliac screws are associated with lower rate of symptomatic screw prominence than iliac screws: radiographic analysis of minimal distance from screw head to skin. World Neurosurg, 2016, 93: 253-260.
33.	Guler UO, Cetin E, Yaman O, et al. Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J, 2015, 24(5): 1085-1091.

1. Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg (Am), 2006, 88(4): 721-728.
2. Bridwell KH, Edwards CC 2nd, Lenke LG. The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct. Spine (Phila Pa 1976), 2003, 28(20): S234-242.
3. Emami A, Deviren V, Berven S, et al. 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), 2002, 27(7): 776-786.
4. Chang TL, Sponseller PD, Kebaish KM, et al. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976), 2009, 34(5): 436-440.
5. Yoshihara H. Rods in spinal surgery: a review of the literature. Spine J, 2013, 13(10): 1350-1358.
6. Jain A, Hassanzadeh H, Strike SA, et al. Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone Joint Surg (Am), 2015, 97(18): 1521-1528.
7. Shen FH, Mason JR, Shimer AL, et al. Pelvic fixation for adult scoliosis. Eur Spine J, 2013, 22 Suppl 2: S265-275.
8. Tis JE, Helgeson M, Lehman RA, et al. A biomechanical comparison of different types of lumbopelvic fixation. Spine (Phila Pa 1976), 2009, 34(24): E866-872.
9. Tumialán LM, Mummaneni PV. Long-segment spinal fixation using pelvic screws. Neurosurgery, 2008, 63(3 Suppl): 183-190.
10. Tsuchiya K, Bridwell KH, Kuklo TR, et al. Minimum 5-year analysis of L₅-S₁ fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976), 2006, 31(3): 303-308.
11. O’Brien JR, Yu WD, Bhatnagar R, et al. An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976), 2009, 34(12): E439-442.
12. Zhu F, Bao HD, Yuan S, et al. Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population. Eur Spine J, 2013, 22(7): 1683-1689.
13. Wu AM, Chi YL, Ni WF, et al. The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study. PeerJ, 2016, 4: e1587.
14. Sponseller PD, Zimmerman RM, Ko PS, et al. Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine (Phila Pa 1976), 2010, 35(20): 1887-1892.
15. 刘臻, 邱勇, 胡宗杉, 等. 经第 2 骶椎骶髂螺钉固定技术在成人脊柱侧后凸畸形中的应用. 中华骨科杂志, 2016, 36(10): 584-590.
16. Park YS, Hyun SJ, Park JH, et al. Radiographic and clinical results of freehand S₂ alar-iliac screw placement for spinopelvic fixation: an analysis of 45 consecutive screws. Clin Spine Surg, 2017, 30(7): E877-E882.
17. Mazur MD, Mahan MA, Shah LM, et al. Fate of S₂-alar-iliac screws after 12-month minimum radiographic follow-up: preliminary results. Neurosurgery, 2017, 80(1): 67-72.
18. Ilyas H, Place H, Puryear A. A comparison of early clinical and radiographic complications of iliac screw fixation versus S₂ alar iliac (S2AI) fixation in the adult and pediatric populations. J Spinal Disord Tech, 2015, 28(4): E199-205.
19. Mazur MD, Ravindra VM, Schmidt MH, et al. Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine, 2015, 23(1): 67-76.
20. Elder BD, Ishida W, Lo SL, et al. Use of S₂-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine (Phila Pa 1976), 2017, 42(3): E142-E149..
21. Ishida W, Elder BD, Holmes C, et al. Comparison between S₂-alar-iliac screw fixation and iliac screw fixation in adult deformity surgery: reoperation rates and spinopelvic parameters. Global Spine J, 2017, 7(7): 672-680.
22. Lattig F, Weckbach S. S₂-alar-iliac screws for extended pelvic fixation in longer lumbar instrumentations: Description of a freehand technique. Oper Orthop Traumatol, 2017, 29(4): 360-372.
23. 王孝宾, 王冰, 李晶, 等. 经骶 2 髂骨螺钉内固定在腰骶段结核稳定性重建中的应用. 中国脊柱脊髓杂志, 2017, 27(5): 392-398.
24. Funao H, Kebaish KM, Isogai N, et al. Utilization of a technique of percutaneous S₂ alar-iliac fixation in immunocompromised patients with spondylodiscitis. World Neurosurg, 2017, 97: 757.e11-757.e18.
25. O’Brien JR, Matteini L, Yu WD, et al. Feasibility of minimally invasive sacropelvic fixation: percutaneous S₂ alar iliac fixation. Spine (Phila Pa 1976), 2010, 35(4): 460-464.
26. Martin CT, Witham TF, Kebaish KM. Sacropelvic fixation: two case reports of a new percutaneous technique. Spine (Phila Pa 1976), 2011, 36(9): E618-621.
27. Nottmeier EW, Pirris SM, Balseiro S, et al. Three-dimensional image-guided placement of S2 alar screws to adjunct or salvage lumbosacral fixation. Spine J, 2010, 10(7): 595-601.
28. O’Brien JR, Yu W, Kaufman BE, et al. Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation. Spine (Phila Pa 1976), 2013, 38(20): E1250-1255.
29. Burns CB, Dua K, Trasolini NA, et al. Biomechanical comparison of spinopelvic fixation constructs: iliac screw versus S₂-alar-iliac screw. Spine Deform, 2016, 4(1): 10-15.
30. Sutterlin CE 3rd, Field A, Ferrara LA, et al. Range of motion, sacral screw and rod strain in long posterior spinal constructs: a biomechanical comparison between S2 alar iliac screws with traditional fixation strategies. J Spine Surg, 2016, 2(4): 266-276.
31. Hoernschemeyer DG, Pashuck TD, Pfeiffer FM. Analysis of the s2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine? Spine J, 2017, 17(6): 875-879.
32. Ishida W, Elder BD, Holmes C, et al. S₂-alar-iliac screws are associated with lower rate of symptomatic screw prominence than iliac screws: radiographic analysis of minimal distance from screw head to skin. World Neurosurg, 2016, 93: 253-260.
33. Guler UO, Cetin E, Yaman O, et al. Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J, 2015, 24(5): 1085-1091.

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