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Biomechanics of sacropelvic fixation: a comprehensive finite element comparison of three techniques

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Abstract

Purpose

Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for complex deformity correction and is commonly associated with pseudoarthrosis, implant failure and loosening. This study compared pedicle screw fixation (PED) with three different sacropelvic fixation techniques, namely iliac screws (IL), S2 alar-iliac screws (S2AI) and laterally placed triangular titanium implants (SI), all in combination with lumbosacral instrumentation, accounting for implant micromotion.

Methods

Existing finite element models of pelvis-L5 of three patients including lumbopelvic instrumentation were utilized. Moments of 7.5 Nm in the three directions combined with a 500 N compressive load were simulated. Measured metrics included flexibility, instrumentation stresses and bone–implant interface loads.

Results

Fixation effectively reduced the sacroiliac flexibility. Compared to PED, IL and S2AI induced a reduction in peak stresses in the S1 pedicle screws. Rod stresses were mostly unaffected by S2AI and SI, but IL demonstrated a stress increase. In comparison with a previous work depicting full osteointegration, SI was found to have similar instrumentation stresses as those due to PED.

Conclusions

Fixation with triangular implants did not result in stress increase on the lumbosacral instrumentation, likely due to the lack of connection with the posterior rods. IL and S2AI had a mild protective effect on S1 pedicle screws in terms of stresses and bone–implant loads. IL resulted in an increase in the rod stresses. A comparison between this study and previous work incorporating full osteointegration demonstrates how these results may be applied clinically to better understand the effects of different treatments on patient outcomes.

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Acknowledgements

Fabio Galbusera received research support from SI-BONE, Inc., to conduct this study.

Funding

The study has been funded by SI-BONE, Inc.

Author information

Authors and Affiliations

  1. Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy

    Fabio Galbusera, Gloria Casaroli, Matteo Panico, Enrico Gallazzi & Marco Brayda-Bruno

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

    Ruchi Chande, Derek Lindsey & Scott Yerby

  3. Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico Di Milano, Milan, Italy

    Tomaso Villa & Matteo Panico

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

    Ali Mesiwala

Authors
  1. Fabio Galbusera
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  2. Gloria Casaroli
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  3. Ruchi Chande
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  4. Derek Lindsey
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  5. Tomaso Villa
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Contributions

GC, MP and FG developed the finite element models. FG developed the computer programs used for the pre-processing of the models. RC and DL supported and revised the development of the models. GC, RC, FG and DL prepared the draft of the manuscript. All authors critically evaluated and interpreted the results of the calculations, revised the manuscript and approved the submitted version. 

Corresponding author

Correspondence to Fabio Galbusera.

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Conflict of interest

RC, DL and SY are employed at SI-BONE, Inc., and have stock/stock options in SI-BONE, Inc. AM is a consultant of SI-BONE, Inc. and conducted clinical research for SI-BONE, Inc.

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Galbusera, F., Casaroli, G., Chande, R. et al. Biomechanics of sacropelvic fixation: a comprehensive finite element comparison of three techniques. Eur Spine J 29, 295–305 (2020). https://doi.org/10.1007/s00586-019-06225-5

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  • DOI: https://doi.org/10.1007/s00586-019-06225-5

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