An S-2 alar iliac pelvic fixation

Matteini, Lauren E.; Kebaish, Khaled M.; Volk, W. Robert; Bergin, Patrick F.; Yu, Warren; O’Brien, Joseph R.

doi:10.3171/2010.1.focus09268

Cited by 49 publications

(32 citation statements)

References 14 publications

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“…In addition, it needs emphasizing that all the data we obtained were based on population with relatively healthy spine who were diagnosed without deformed skeletal structure and that the data should be used to guide screws insertion in patients without pelvic obliquity or pelvic asymmetry. Matteini et al [29] reported a case of postlaminectomy degenerative scoliosis with bilaterally insertion of S2AI screws. In this case report, angulation was directed toward the greater trochanter and approximately 30°anterior from the floor, and corresponding data in the present study is Sag angle which is around 29°.…”

Section: Discussionmentioning

confidence: 99%

Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population

Zhu

Bao

et al. 2013

Eur Spine J

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Objective To provide radiographic parameters for optimal placement of posterior second sacral alar iliac (S2AI) screw for instrumentation and fusion of scoliosis to the second sacral level in a Chinese population. Methods S2AI screw trajectories were mapped on threedimensional computed tomography (3DCT) reconstructions of 60 normal adult pelvises. 1 mm inferior and 1 mm lateral to the S1 dorsal foramen were chosen as the entry point, and ideal S2AI screw trajectories were explored by rotating and cutting the 3D pelvis, ensuring that the trajectories were of maximum length and width. The directions and depth of these determined trajectories were then measured. Results The ideal S2AI screw trajectories could be found in each pelvis. The left and right screw trajectory parameters for males were shown as follows: angulation was L 29.15 ± 8.60°vs. R 29.96 ± 8.28°(p = 0.286) caudally in the sagittal plane and L 36.49 ± 3.14°vs. R 37.16 ± 3.14°(p = 0.165) laterally in the transverse plane. The maximal and intrasacral lengths of trajectory were L 121.25 ± 8.33 vs. R 120.63 ± 7.54 mm (p = 0.460) and L 26.20 ± 3.31 vs. R 26.92 ± 4.76 mm (p = 0.268). The entry point was L 28.87 ± 3.33 vs. R 29.79 ± 3.55 mm (p = 0.186) lateral to the second sacral midline, and L 44.14 ± 11.87 vs. R 43.89 ± 12.53 mm (p = 0.687) underneath the skin. The trajectories for females were more caudal (L: 34.50 ± 6.56°vs. 29.15 ± 8.60°, p = 0.009; R: 35.72 ± 7.53°vs. 29.96 ± 8.28°, p = 0.007) in the sagittal plane, but the lateral angulation in the transverse plane showed no difference between genders (p [ 0.05). The female iliac medullar cavities were obviously narrower than those of males (L: 14.76 ± 2.46 vs. 16.98 ± 3.52, p = 0.006; R: 14.94 ± 2.60 vs. 17.00 ± 2.81, p = 0.005). Although the average maximal length of trajectories for females were about 5 mm shorter than those of males, intrasacral length were equal to those of males. Furthermore, both the distance from entry point to the S2 midline and skin in the transverse plane showed no difference between genders. Conclusion The feasibility to insert S2AI screws to the sacrum and ilium in an Asian population along with the ideal entry angle and length of trajectory were identified for clinical practice.

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Section: Discussionmentioning

confidence: 99%

Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population

Zhu

Bao

et al. 2013

Eur Spine J

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“…Pelvic fixation may also Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors be considered for high-grade spondylolisthesis, unstable sacral fractures, or sacral tumors. 6 Various augmentations have been used to help protect S-1 screws such as the Galveston technique, 1 S-2 screws, 13 the 4-rod technique, 17 S-2 alar iliac screws, 11 and a combination of S-1 and iliac screws (S1-iliac screws).…”

Section: ©Aans 2013mentioning

confidence: 99%

Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors

Cho

Mason²,

Smith

et al. 2013

SPI

119

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Object Lumbopelvic fixation provides biomechanical support to the base of the long constructs used for adult spinal deformity. However, the failure rate of the lumbopelvic fixation and its risk factors are not well known. The authors' objective was to report the failure rate and risk factors for lumbopelvic fixation in long instrumented spinal fusion constructs performed for adult spinal deformity. Methods This retrospective review included 190 patients with adult spinal deformity who had long construct instrumentation (> 6 levels) with iliac screws. Patients' clinical and radiographic data were analyzed. The patients were divided into 2 groups: a failure group and a nonfailure group. A minimum 2-year follow-up was required for inclusion in the nonfailure group. In the failure group, all patients were included in the study regardless of whether the failure occurred before or after 2 years. In both groups, the patients who needed a revision for causes other than lumbopelvic fixation (for example, proximal junctional kyphosis) were also excluded. Failures were defined as major and minor. Major failures included rod breakage between L-4 and S-1, failure of S-1 screws (breakage, halo formation, or pullout), and prominent iliac screws requiring removal. Minor failures included rod breakage between S-1 and iliac screws and failure of iliac screws. Minor failures did not require revision surgery. Multiple clinical and radiographic values were compared between major failures and nonfailures. Results Of 190 patients, 67 patients met inclusion criteria and were enrolled in the study. The overall failure rate was 34.3%; 8 patients had major failure (11.9%) and 15 had minor failure (22.4%). Major failure occurred at a statistically significant greater rate in patients who had undergone previous lumbar surgery, had greater pelvic incidence, and had poor restoration of lumbar lordosis and/or sagittal balance (that is, undercorrection). Patients with a greater number of comorbidities and preoperative coronal imbalance showed trends toward an increase in major failures, although these trends did not reach statistical significance. Age, sex, body mass index, smoking history, number of fusion segments, fusion grade, and several other radiographic values were not shown to be associated with an increased risk of major failure. Seventy percent of patients in the major failure group had anterior column support (anterior lumbar interbody fusion or transforaminal lumbar interbody fusion) while 80% of the nonfailure group had anterior column support. Conclusions The incidence of overall failure was 34.3%, and the incidence of clinically significant major failure of lumbopelvic fixation after long construct fusion for adult spinal deformity was 11.9%. Risk factors for major failures are a large pelvic incidence, revision surgery, and failure to restore lumbar lordosis and sagittal balance. Surgeons treating adult spinal deformity who use lumbopelvic fixation should pay special attention to restoring optimal sagittal alignment to prevent lumbopelvic fixation failure.

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“…Stereotactic placement of catheters into craniopharyngioma cysts with consecutive injection of either radioactive or chemotherapeutic agents has been performed (Steinbok and Hukin, 2010; Barriger et al, 2011). More recently, the use of interferon-alpha as a therapeutic agent was reported (Cavalheiro et al, 2010).…”

Section: Intracystic Therapiesmentioning

confidence: 99%

Surgical Strategies in Childhood Craniopharyngioma

Flitsch¹,

Müller²,

Burkhardt³

2011

Front. Endocrin.

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Craniopharyngiomas are biologically benign lesions (WHO Grade 1) of the sellar and suprasellar region, associated with a serious morbidity. About 50% of these tumors become clinically apparent during childhood. Clinical symptoms include headaches, chiasm syndrome, hydrocephalus, pituitary insufficiencies, and obesity. Growth arrest is a typical symptom in children. The treatment of craniopharyngiomas includes surgery as well as radiotherapy. The goal of surgery varies according to the tumor location and extension and may range from complete resection to biopsy. Surgical complications are well known and cause constant evaluation of surgical strategies. Diencephalic obesity is related to surgical manipulation of hypothalamic tissue. Therefore, a classification system for craniopharyngiomas based on preoperative MRI is suggested by the authors. Recurrences are frequent in craniopharyngiomas, even after complete or gross-total resection. Radiotherapy is therefore recommended to patients with incomplete resections. However, the ideal time for radiotherapy after surgery is under discussion. The treatment of craniopharyngiomas requires an interdisciplinary and multimodal approach. Each patient should receive an individually tailored treatment. Surgically, different approaches as well as different degrees of resection can be considered, depending on tumor location and tumor extension.

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An S-2 alar iliac pelvic fixation

Cited by 49 publications

References 14 publications

Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population

Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population

Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors

Surgical Strategies in Childhood Craniopharyngioma

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