Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

Abstract

Lumbosacral instrumentation continues to be challenging due to complex biomechanical force distributions and poor sacral bone quality. Various techniques have therefore been established. The aim of this study was to investigate the outcome of patients treated with S2-alar-iliac (S2AI), S2-alar (S2A), and iliac (I) instrumentation as the most caudal level. Sixty patients underwent one of the 3 techniques between January 2012 and June 2017 (S2AI 18 patients, S2A 20 patients, I 22 patients). Mean age was 70.4 ± 8.5 years. Screw loosening (SL) and sacroiliac joint (SIJ) pain were evaluated during the course at 3-month and maximum follow-up (FU). All patients completed 3-month FU, the mean FU period was 2.5 ± 1.5 years (p = 0.38), and a median of 5 segments was operated on (p = 0.26), respectively. Bone mineral density (BMD), derived opportunistically from computed tomography (CT), did not significantly differ between the groups (p = 0.66), but cages were more frequently implanted in patients of the S2A group (p = 0.04). SL of sacral or iliac screws was more common in patients of the S2A and I groups compared with the S2AI group (S2AI 16.7%, S2A 55.0%, I 27.3% of patients; p = 0.03). SIJ pain was more often improved in the S2AI group not only after 3 months but also at maximum FU (S2AI 61.1%, S2A 25.0%, I 22.7% of patients showing improvement; p = 0.02). Even in shorter or mid-length lumbar or thoracolumbar constructs, S2AI might be considered superior to S2A and I instrumentation due to showing lower incidences of caudal SL and SIJ pain.

Study of Sacroiliac fixation in patients with sacroiliitis associated with L5 Lythesis

“…Highly statistically significant (p-value < 0.001) decreased postoperative ODI (31. 7 This table shows the description of follow up days in all studied patients. The mean follow up days of all studied patients was 8.2 ± 3.2 days with minimum follow up days of 6 days and maximum follow up days of 14 days.…”

S2AI pelvic fixation is an important factor affecting sagittal spinal parameters in ADS patients in the short term after surgery: a retrospective study

“…Numerous studies have con rmed the advantages of S2AI technology, Researchers such as Elder et al [10] have found that both methods of pelvic xation were effective in relieving preoperative pain and dysfunction, and there was no signi cant difference in the probability of L5-S1 pseudoarthrosis and sacroiliac joint pain between the two xation methods, but compared with IS technique, the application of S2AI screw can signi cantly reduce the risk of incision infection, dehiscence, symptomatic screw protrusion, and reoperation. And Krieg et al [11] argue that the S2AI screw had a lower rate of sacroiliac joint pain and the possibility of screw loosening than IS in thoracolumbar surgery of the same length. This is also consistent with the results of a META analysis from 5 retrospective studies by Garza et al [12] .…”

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

“…We retrieved 672 articles, of which 14 met the inclusion criteria [2,[8][9][10][11][12][13][14][16][17][18][19][20][21]. Three studies focused on S2AI [11,13,21], six on IS [8][9][10]12,14,18], and five on S2AI and IS [2,16,17,19,20].…”

“…We retrieved 672 articles, of which 14 met the inclusion criteria [2,[8][9][10][11][12][13][14][16][17][18][19][20][21]. Three studies focused on S2AI [11,13,21], six on IS [8][9][10]12,14,18], and five on S2AI and IS [2,16,17,19,20]. The flow chart in Fig.…”