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Biomechanical comparison of sacral and transarticular sacroiliac screw fixation

  • Biomechanics
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

A detailed finite element analysis of screw fixation in the sacrum and pelvis.

Objective

To biomechanically assess and compare the fixation performance of sacral and transarticular sacroiliac screws.

Summary of background data

Instrumentation constructs are used to achieve fixation and stabilization for the treatment of spinopelvic pathologies. The optimal screw trajectory and type of bone engagement to caudally anchor long fusion constructs are not yet known.

Methods

A detailed finite element model of the sacroiliac articulation with two different bone densities was developed. Two sacral and one transarticular sacroiliac screw trajectories were modeled with different diameters (5.5 and 6.5 mm) and lengths (uni-cortical, bi-cortical and quad-cortical purchase). Axial pullout and flexion/extension toggle forces were applied on the screws representing intra and post-operative loads. The force–displacement results and von Mises stresses were used to characterize the failure pattern.

Results

Overall, sacroiliac screws provided forces to failure 2.75 times higher than sacral fixation screws. On the contrary, the initial stiffness was approximately half as much for sacroiliac screws. High stresses were located at screw tips for the sacral trajectories and near the cortical bone screw entry points for the sacroiliac trajectory. Overall, the diameter and length of the screws had significant effects on the screw fixation (33% increase in force to failure; 5% increase in initial stiffness). A 20% drop in bone mineral density (lower bone quality) decreased the initial stiffness by 25% and the force to failure by 5–10%. High stresses and failure occurred at the screw tip for uni- and tri-cortical screws and were close to trabecular–cortical bone interface for bi-cortical and quad-cortical screws.

Conclusions

Sacroiliac fixation provided better anchorage than sacral fixation. The transarticular purchase of the sacroiliac trajectory resulted in differences in failure pattern and fixation performance.

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Funding

Funding was provided by Natural Sciences and Engineering Research Council of Canada (Grant Number: PCIPJ-346145-16) and Aix-Marseille Université (Grant Number: ANR 11-IDEX-0001-02).

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada

    Léo Fradet, Rohan-Jean Bianco & Carl-Éric Aubin

  2. Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada

    Léo Fradet & Carl-Éric Aubin

  3. International Laboratory - Spine Imaging and Biomechanics, Montreal, Canada

    Léo Fradet & Carl-Éric Aubin

  4. Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille Université, Boulevard Pierre Dramard, 13916, Marseille Cedex 20, France

    Rohan-Jean Bianco

  5. International Laboratory - Spine Imaging and Biomechanics, Marseille, France

    Rohan-Jean Bianco

  6. Department of Orthopaedics and Rehabilitation, Oregon Health & Sciences University, 3181, Portland, OR, USA

    Robert Tatsumi

  7. Medtronic Spine, Memphis, TN, USA

    John Coleman

Authors
  1. Léo Fradet
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  2. Rohan-Jean Bianco
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  3. Robert Tatsumi
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  4. John Coleman
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  5. Carl-Éric Aubin
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Corresponding author

Correspondence to Carl-Éric Aubin.

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Conflict of interest

Funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair with Medtronic of Canada, PCIPJ-346145-16), and by a research grant from Medtronic. Relevant financial activities of authors outside the submitted work: consultancy with Medtronic, grants or research support from Medtronic. The initial model used in this study also was supported in part by a grant from the A*MIDEX Foundation (Aix-Marseille University Initiative of Excellence, no ANR 11-IDEX-0001-02). The devices are FDA cleared or approved by corresponding national agency for this indication.

IRB/ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional ethical research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approbation for the current study was obtained from our institutional ethics review board.

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Fradet, L., Bianco, RJ., Tatsumi, R. et al. Biomechanical comparison of sacral and transarticular sacroiliac screw fixation. Spine Deform 8, 853–862 (2020). https://doi.org/10.1007/s43390-020-00108-2

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  • DOI: https://doi.org/10.1007/s43390-020-00108-2

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