Evaluation of iliac screw, S2 alar-iliac screw and laterally placed triangular titanium implants for sacropelvic fixation in combination with posterior lumbar instrumentation: a finite element study

European Spine Journal volume 28, pages1724–1732(2019)Cite this article

Abstract

Purpose

This study aimed to implement laterally placed triangular titanium implants as a technique of sacropelvic fixation in long posterior lumbar instrumentation and to characterize the effects of iliac screws, S2 alar-iliac screws and of triangular implants on rod and S1 pedicle screw stresses.

Methods

Four female models of the lumbopelvic spine were created. For each of them, five finite element models replicating the following configurations were generated: intact, posterior fixation with pedicle screws to S1 (PED), with PED and iliac screws (IL), with PED and S2 alar-iliac (S2AI) screws, and with PED and bilateral triangular titanium implants (SI). Simulations were conducted in compression, flexion–extension, lateral bending and axial rotation. Rod stresses in the L5-S1 segment as well as in the S1 pedicle screws were compared.

Results

One anatomical model was not simulated due to dysmorphia of the sacroiliac joints. PED resulted in the highest implant stresses. Values up to 337 MPa in lateral bending were noted, which were more than double than the other configurations. When compared with IL, S2AI and SI resulted in lower stresses in both screws and rods (on average 33% and 41% for S2AI and 17% and 50% for SI).

Conclusions

Implant stresses after S2AI and SI fixations were lower than those attributable to IL. Therefore, pedicle screws and rods may have a lower risk of mechanical failure when coupled with sacropelvic fixation via S2AI or triangular titanium implants, although the risk of clinical loosening remains an area of further investigation.

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Acknowledgements

We thank Dr. Enrico Gallazzi for critical reading of the manuscript.

Funding

Funding by SI-BONE Inc. (Santa Clara, CA, USA) is gratefully acknowledged.

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Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Gloria Casaroli, Fabio Galbusera & Marco Brayda-Bruno

  2. SI-BONE, Inc., San Jose, CA, USA

    Ruchi Chande, Derek Lindsey & Scott Yerby

  3. Southern California Center for Neuroscience and Spine, Pomona, CA, USA

    Ali Mesiwala

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  1. Gloria Casaroli
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  2. Fabio Galbusera
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Correspondence to Fabio Galbusera.

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Casaroli, G., Galbusera, F., Chande, R. et al. Evaluation of iliac screw, S2 alar-iliac screw and laterally placed triangular titanium implants for sacropelvic fixation in combination with posterior lumbar instrumentation: a finite element study. Eur Spine J 28, 1724–1732 (2019). https://doi.org/10.1007/s00586-019-06006-0

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Keywords

  • Sacroiliac joint
  • Sacropelvic fixation
  • Finite element analysis
  • Alar-iliac screws
  • Iliac screws
  • Triangular implants