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European Spine Journal

, Volume 22, Issue 7, pp 1683–1689 | Cite as

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

  • F. Zhu
  • H. D. Bao
  • S. Yuan
  • B. Wang
  • J. Qiao
  • Z. Z. Zhu
  • Z. Liu
  • Y. T. Ding
  • Y. QiuEmail author
Original Article

Abstract

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 three-dimensional 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.

Keywords

Second sacral alar iliac (S2AI) screw Three-dimensional computed tomography (3DCT) imaging Neuromuscular scoliosis 

Notes

Acknowledgments

Thanks are due to Mark Bentley for article revision. This work was sponsored by National Public Health Benefit Research foundation, China (Grant No. 201002018). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest

None.

References

  1. 1.
    Weistroffer JK et al (2008) Complications in long fusions to the sacrum for adult scoliosis: minimum five-year analysis of fifty patients. Spine (Phila Pa 1976) 33:1478–1483. doi: 10.1097/BRS.0b013e3181753c53 CrossRefGoogle Scholar
  2. 2.
    Modi HN et al (2009) Surgical correction and fusion using posterior-only pedicle screw construct for neuropathic scoliosis in patients with cerebral palsy: a three-year follow-up study. Spine (Phila Pa 1976) 34:1167–1175. doi: 10.1097/BRS.0b013e31819c38b7 CrossRefGoogle Scholar
  3. 3.
    Peelle MW, Lenke LG, Bridwell KH, Sides B (2006) Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: galveston rod versus iliac and lumbosacral screws. Spine (Phila Pa 1976) 31:2392–2398. doi: 10.1097/01.brs.0000238973.13294.16 (discussion 2399)CrossRefGoogle Scholar
  4. 4.
    Cassidy C, Craig CL, Perry A, Karlin LI, Goldberg MJA (1994) Reassessment of spinal stabilization in severe cerebral palsy. J Pediatr Orthop 14:731–739PubMedCrossRefGoogle Scholar
  5. 5.
    Sengupta DK, Mehdian SH, McConnell JR, Eisenstein SM, Webb JK (2002) Pelvic or lumbar fixation for the surgical management of scoliosis in duchenne muscular dystrophy. Spine (Phila Pa 1976) 27:2072–2079CrossRefGoogle Scholar
  6. 6.
    Ilharreborde B et al (2009) Intrasacral rod fixation for pediatric long spinal fusion: results of a prospective study with a minimum 5-year follow-up. J Pediatr Orthop 29:594–601. doi: 10.1097/BPO.0b013e3181b2b403 PubMedCrossRefGoogle Scholar
  7. 7.
    Early S, Mahar A, Oka R, Newton P (2005) Biomechanical comparison of lumbosacral fixation using Luque-Galveston and Colorado II sacropelvic fixation: advantage of using locked proximal fixation. Spine (Phila Pa 1976) 30:1396–1401CrossRefGoogle Scholar
  8. 8.
    Allen BL Jr, Ferguson RL (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine (Phila Pa 1976) 9:388–394CrossRefGoogle Scholar
  9. 9.
    Lebwohl NH et al (2002) Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine (Phila Pa 1976) 27:2312–2320. doi: 10.1097/01.brs.0000030302.08190.6c CrossRefGoogle Scholar
  10. 10.
    Erickson MA, Oliver T, Baldini T, Bach J (2004) Biomechanical assessment of conventional unit rod fixation versus a unit rod pedicle screw construct: a human cadaver study. Spine (Phila Pa 1976) 29:1314–1319CrossRefGoogle Scholar
  11. 11.
    Phillips JH, Gutheil JP, Knapp Jr (2007) Iliac screw fixation in neuromuscular scoliosis. Spine (Phila Pa 1976) 32:1566–1570. doi: 10.1097/BRS.0b013e318067dcff CrossRefGoogle Scholar
  12. 12.
    Stevens DB, Beard C (1989) Segmental spinal instrumentation for neuromuscular spinal deformity. Clin Orthop Relat Res 242:164–168PubMedGoogle Scholar
  13. 13.
    Teli MG et al (2006) Spinal fusion with Cotrel-Dubousset instrumentation for neuropathic scoliosis in patients with cerebral palsy. Spine (Phila Pa 1976) 31:E441–E447. doi: 10.1097/01.brs.0000221986.07992.fb CrossRefGoogle Scholar
  14. 14.
    Miladi LT, Ghanem IB, Draoui MM, Zeller RD, Dubousset JF (1997) Iliosacral screw fixation for pelvic obliquity in neuromuscular scoliosis. A long-term follow-up study. Spine (Phila Pa 1976) 22:1722–1729CrossRefGoogle Scholar
  15. 15.
    Sponseller PD et al (2010) Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine (Phila Pa 1976) 35:1887–1892. doi: 10.1097/BRS.0b013e3181e03881 CrossRefGoogle Scholar
  16. 16.
    Chang TL, Sponseller PD, Kebaish KM, Fishman EK (2009) Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976) 34:436–440. doi: 10.1097/BRS.0b013e318194128c CrossRefGoogle Scholar
  17. 17.
    Edwards CC 2nd et al (2004) Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine (Phila Pa 1976) 29:1996–2005CrossRefGoogle Scholar
  18. 18.
    Edwards CC 2nd et al (2003) Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5-S1 disc. Spine (Phila Pa 1976) 28:2122–2131. doi: 10.1097/01.brs.0000084266.37210.85 CrossRefGoogle Scholar
  19. 19.
    Wang MY, Ludwig SC, Anderson DG, Mummaneni PV (2008) Percutaneous iliac screw placement: description of a new minimally invasive technique. Neurosurg Focus 25:E17. doi: 10.3171/foc/2008/25/8/e17 PubMedCrossRefGoogle Scholar
  20. 20.
    Camp JF, Caudle R, Ashmun RD, Roach J (1990) Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study. Spine (Phila Pa 1976) 15:932–941CrossRefGoogle Scholar
  21. 21.
    Gau YL, Lonstein JE, Winter RB, Koop S, Denis F (1991) Luque-Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 68 patients. J Spinal Disord 4:399–410PubMedCrossRefGoogle Scholar
  22. 22.
    McCord DH, Cunningham BW, Shono Y, Myers JJ, McAfee PC (1992) Biomechanical analysis of lumbosacral fixation. Spine (Phila Pa 1976) 17:S235–S243CrossRefGoogle Scholar
  23. 23.
    Linville DII CB, Dmitriev A (2004) Does iliac crest bone graft harvest affect iliac screw fixation–an in vitro biomechanical study? In: Paper presented at The Scoliosis Research Society 39th Annual Meeting, Buenos Aires, ArgentinaGoogle Scholar
  24. 24.
    Kuklo TR et al (2001) Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:1976–1983CrossRefGoogle Scholar
  25. 25.
    O’Brien JR, Yu WD, Bhatnagar R, Sponseller P, Kebaish KM (2009) An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976) 34:E439–E442. doi: 10.1097/BRS.0b013e3181a4e3e4 CrossRefGoogle Scholar
  26. 26.
    O’Brien JR, Matteini L, Yu WD, Kebaish KM (2010) Feasibility of minimally invasive sacropelvic fixation: percutaneous S2 alar iliac fixation. Spine (Phila Pa 1976) 35:460–464. doi: 10.1097/BRS.0b013e3181b95dca CrossRefGoogle Scholar
  27. 27.
    Kwan MK, Jeffry A, Chan CY, Saw LB (2012) A radiological evaluation of the morphometry and safety of S1, S2 and S2-ilium screws in the Asian population using three dimensional computed tomography scan: an analysis of 180 pelvis. Surg Radiol Anat : SRA 34:217–227. doi: 10.1007/s00276-011-0919-2 PubMedCrossRefGoogle Scholar
  28. 28.
    Lanzieri CF, Hilal SK (1984) Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen. AJR Am J Roentgenol 143:165–168PubMedCrossRefGoogle Scholar
  29. 29.
    LE Matteini et al (2010) An S-2 alar iliac pelvic fixation. Technical note. Neurosurg Focus 28:E13. doi: 10.3171/2010.1.focus09268 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • F. Zhu
    • 1
  • H. D. Bao
    • 1
  • S. Yuan
    • 1
  • B. Wang
    • 1
  • J. Qiao
    • 1
  • Z. Z. Zhu
    • 1
  • Z. Liu
    • 1
  • Y. T. Ding
    • 1
  • Y. Qiu
    • 1
    Email author
  1. 1.Spine SurgeryThe Affiliated Drum Town Hospital of Nanjing University Medical SchoolNanjingChina

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