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S2 alar-iliac screw versus traditional iliac screw for spinopelvic fixation: a systematic review of comparative biomechanical studies

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Abstract

Purpose

To review and compare biomechanical properties between S2 alar-iliac (S2AI) screws and traditional iliac screws for spinopelvic fixation.

Methods

A systematic review was performed according to PRISMA guidelines. All clinical, cadaveric, and finite-element model (FEM) studies that compared the biomechanical properties between S2AI screws and traditional iliac screws were included. Study methodological quality for cadaveric studies were analyzed using the Quality Appraisal for Cadaveric Studies (QUACS) scale.

Results

Eight studies (4 cadaveric, 4 FEM) analyzing 58 S2AI screws and 48 traditional iliac screws were included. According to QUACS, the overall methodological quality was “moderate to good” for all four cadaveric studies. All four cadaveric studies found no difference in biomechanical stiffness, screw toggle, rod strain, and/or load-to-failure between the S2AI screws and traditional iliac screws for spinopelvic fixation. All four FEM studies found that S2AI screws were associated with lower implant stresses compared to traditional iliac screws.

Conclusions

There is moderate biomechanical evidence to suggest that there is no significant difference in stability and stiffness between S2AI screws and traditional iliac screws for spinopelvic fixation. However, there is some evidence to support that the placement of S2AI screws may have lower implant stresses on the overall lumbosacral instrumentation compared to traditional iliac screws.

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Funding

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Authors and Affiliations

  1. Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA

    Takashi Hirase, Brian Phelps, Varan Haghshenas, Comron Saifi & Darrell S. Hanson

  2. Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA

    Takashi Hirase, Caleb Shin & Jeremiah Ling

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  1. Takashi Hirase
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Contributions

TH made substantial contributions to the conception and design of work, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. CS, JFL, BP, VH made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. CS, DSH senior surgeon who made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work.

Corresponding author

Correspondence to Takashi Hirase.

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Conflict of interest

Takashi Hirase, Caleb Shin, Jeremiah Ling, Brian Phelps, and Varan Haghshenas declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article. Comron Saifi has the following disclosures: Acquisition of Vertera Inc. by NuVasive’ Shares: Stock or stock Options; Nuvasive: Paid consultant. Darrell S Hanson has the following disclosures: DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker; Medtronic Sofamor Danek: Paid consultant; Paid presenter or speaker.

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No ethical approval was required for this systematic review.

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Consent for publication was completed by all authors in this work.

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Hirase, T., Shin, C., Ling, J. et al. S2 alar-iliac screw versus traditional iliac screw for spinopelvic fixation: a systematic review of comparative biomechanical studies. Spine Deform 10, 1279–1288 (2022). https://doi.org/10.1007/s43390-022-00528-2

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  • DOI: https://doi.org/10.1007/s43390-022-00528-2

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