Percutaneous iliac screw placement: description of a new minimally invasive technique

Wang, Michael Y.; Ludwig, Steven C.; Anderson, D. Greg; Mummaneni, Praveen V.

doi:10.3171/foc/2008/25/8/e17

Cited by 46 publications

(21 citation statements)

References 23 publications

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“…Multiple studies have shown that long instrumentation to the sacrum without supplemental pelvic fixation predisposes to implant failure [17][18][19]. Methods of fixation to achieve effective iliac fixation have evolved over from Galveston technique to iliac screws in recent decades.…”

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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“…The potential upside of dual screw fixation would be greater biomechanical strength with decreased instrumentation-related postoperative complications such as screw pullout, pseudarthrosis, and sacral insufficiency fracture. 16,17 The potential downside of a second screw is added muscle and fascia dissection, increased postoperative pain, problems with sexual function, 2,4 increased cost, and possibly increased infection risk due to the added exposure and hardware.…”

Section: Discussionmentioning

confidence: 99%

Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

Saigal¹,

Lau²,

Wadhwa³

et al. 2014

FOC

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Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

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“…Iliac screws are placed using the obturator outlet view for percutaneous cannulation as previously described. 19 For iliac screws a window is made in the posterior superior iliac spine to avoid screw head prominence. Each needle is then exchanged for a K wire.…”

Section: Surgical Techniquementioning

confidence: 99%

Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation

Wang

2013

SPI

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Object The treatment of adult spinal deformity (ASD) remains a challenge for the spine surgeon. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained elusive in cases involving the MIS approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction. Methods Over an 18-month period 25 patients with thoracolumbar scoliosis were treated surgically. The mean patient age was 72 years, and 68% of the population was female. Patients were treated with multilevel facet osteotomies and interbody fusion in which expandable cages (mean 3.2 levels) were placed and percutaneous screw fixation (mean 5.3 levels) was performed. Seven patients underwent supplemental percutaneous iliac fixation. Results All patients underwent MIS without conversion to a traditional open procedure. The mean operative time was 273 mins and the mean blood loss was 416 ml. There were no intraoperative complications. The Cobb angle over the scoliotic deformity improved from a mean of 29.2° to that of 9.0° (p < 0.001). Lumbar lordosis between L-1 and S-1 improved from a mean of 27.8° to one of 42.6° (p < 0.001). Sagittal vertical axis improved from 7.4 cm to 4.3 cm (p = 0.001). Numeric pain scale scores improved as well, an average of 3.3 and 4.2 for the leg and back, respectively. A mean improvement of 20.8 points on the Oswestry Disability Index was seen at 12 months. Complications included: two cases requiring hardware repositioning, one case of screw pullout, one asymptomatic pedicle screw breach, prolonged hospitalization from constipation, and one acute coronary syndrome developing 3 days after surgery without myocardial damage. Conclusions An expanding body of evidence suggests that sagittal balance remains a keystone for good outcomes after ASD surgery. Minimally invasive surgery that involves a combination of osteotomies, interbody height restoration, and advanced fixation techniques may achieve this goal in patients with less severe deformities. While feasibility will have to be proven with larger series and improved surgical methods, the present technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.

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Percutaneous iliac screw placement: description of a new minimally invasive technique

Cited by 46 publications

References 23 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

Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation

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