Lumbosacral fixation using sacroiliac buttress screws: a modification to the Jackson technique with intrasacral rods

Abstract

BackgroundThe use of intrasacral rods has been previously reported for posterior lumbosacral fixation. However, problems associated with this technique include poor stability of the rod in the sacrum, difficulty in contouring the rod to fit the lateral sacral mass, and the complicated assembly procedure for the rod and pedicle screws in the thoracolumbar segments after insertion of the rod into the sacrum.MethodsWe used a screw with a polyaxial head instead of an intrasacral rod, which was inserted into the lateral sacral mass and assembled to the rod connected cephalad to pedicle screws. The dorsal side of the screw was stabilized by the sacral subchondral bone at the sacroiliac joint with iliac buttress coverage, and the tip of the screw was anchored by the sacral cortex.ResultsThree different cases were used to illustrate lumbosacral fixation using intrasacral screws as an anchor for the spinal instrumentation. Effective resistance of flexural bending moment and fusion were achieved in these patients at the lumbosacral level.ConclusionsAn intrasacral screw can be stabilized by subchondral bone with iliac buttress coverage at the dorsal and ventral sacral cortex. Posterior spinal fusion with this screw technique enables easier assembly of the instrumentation and presents better stabilization than that provided by the previously reported intrasacral rod technique for correction and fusion of thoracolumbar kyphoscoliosis.

Early Medical Complications and Delayed Discharge after Spinopelvic Fusion: A Comparative Analysis of 887 NSQIP Cases from 2006 to 2016

“…Each technique has a different associated fusion rate and complication profile. Studies exist which compare different techniques for SPF, including Jackson intrasacral rods (largely a historical technique) 10,11) , bicortical and tricortical sacral pedicle screw techniques 12,13) , iliac bolts 14) , and S2AI screws 15) . These techniques have been used with varying degrees of success and are associated with different complication profiles.…”

Spinopelvic fixation: indications, anatomical and biomechanical aspects and historical development of methods

“…Есть сообщения об успешном применении данного метода при оперативной коррекции сколиоза у детей [57]. Fukuda et al [58] в 2014 г. описали модификацию методики Jackson с применением интрасакрального введения полиаксиальных винтов, что позволило избежать сложности при контурировании и установке стержня.…”

Sacroiliac Joint Degeneration After Lumbopelvic Fixation

“…Therefore, Fukuda et al reported sacroiliac buttress screws (SBS) as an alternative for these intrasacral rods. 5 In their technique, polyaxial screws were inserted into the sacrum, instead of the rods, and the polyaxial screw head provides an easier assembly of the rods and screws than intrasacral rods.…”

“…1 Solitary fixation, using S1 pedicle screws, is often associated with insufficient outcomes in long adult fusions. 2 Therefore, additional sacral and pelvic fixation techniques to spinal instrumentations have been developed to reduce complications and promote fusion at the lumbosacral junction, 3 including intrasacral rods and screws, 4,5 S2 pedicle screws, 6 iliac screws, 2,7 and S2 alar iliac screws (SAI). 8,9 Although various surgical techniques and instrumentations have been reported, they can be grouped into 2 types, i.e.…”