Skip to main content

Advertisement

SpringerLink
Log in

Optimization of S2-alar-iliac screw (S2AI) fixation in adult spine deformity using a comprehensive genetic algorithm and finite element model personalized to patient geometry and bone mechanical properties

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

Abstract

Purpose

To optimize the biomechanical performance of S2AI screw fixation using a genetic algorithm (GA) and patient-specific finite element analysis integrating bone mechanical properties.

Methods

Patient-specific pelvic finite element models (FEM), including one normal and one osteoporotic model, were created from bi-planar multi-energy X-rays (BMEXs). The genetic algorithm (GA) optimized screw parameters based on bone mass quality (BM method) while a comparative optimization method maximized the screw corridor radius (GEO method). Biomechanical performance was evaluated through simulations, comparing both methods using pullout and toggle tests.

Results

The optimal screw trajectory using the BM method was more lateral and caudal with insertion angles ranging from 49° to 66° (sagittal plane) and 29° to 35° (transverse plane). In comparison, the GEO method had ranges of 44° to 54° and 24° to 30° respectively. Pullout forces (PF) using the BM method ranged from 5 to 18.4 kN, which were 2.4 times higher than the GEO method (2.1–7.7 kN). Toggle loading generated failure forces between 0.8 and 10.1 kN (BM method) and 0.9–2.9 kN (GEO method). The bone mass surrounding the screw representing the fitness score and PF of the osteoporotic case were correlated (R2 > 0.8).

Conclusion

Our study proposed a patient-specific FEM to optimize the S2AI screw size and trajectory using a robust BM approach with GA. This approach considers surgical constraints and consistently improves fixation performance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The numerical data supporting the results of this study are available from the corresponding author upon reasonable request.

References

  1. Adrian K, Aftab Y, Patrick L (2020) Adult degenerative scoliosis—a literature review. Interdiscipl Neurosurg 20:100661

    Article  Google Scholar 

  2. Diebo BG, Shah NV, Boachie-Adjei O et al (2019) Adult spinal deformity. Lancet 394:160–172

    Article  PubMed  Google Scholar 

  3. Moshirfar A, Rand FF, Sponseller PD, et al. (2005) Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am 87(Suppl 2):89–106

  4. Yang H, Pan A, Hai Y et al (2023) Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery. Front Bioeng Biotechnol 11:1148342

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nanda A, Manghwani J, Kluger PJ (2020) Sacropelvic fixation techniques—current update. J Clin Orthop Trauma 11:853–862

    Article  PubMed  PubMed Central  Google Scholar 

  6. Keorochana G, Arirachakaran A, Setrkraising K et al (2019) Comparison of complications and revisions after sacral 2 alar iliac screw and iliac screw fixation for sacropelvic fixation in pediatric and adult populations: systematic review and meta-analysis. World Neurosurg 132(408–20):e1

    Google Scholar 

  7. Guler UO, Cetin E, Yaman O et al (2015) Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J 24:1085–1091

    Article  PubMed  Google Scholar 

  8. Martin CT, Holton KJ, Elder BD et al (2023) Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors. J Neurosurg Spine 38:98–106

    Article  PubMed  Google Scholar 

  9. Martin CT, Polly DW, Holton KJ et al (2022) Acute failure of S2-alar-iliac screw pelvic fixation in adult spinal deformity: novel failure mechanism, case series, and review of the literature. J Neurosurg Spine 36:53–61

    Article  PubMed  Google Scholar 

  10. Eastlack RK, Soroceanu A, Mundis GM, Jr., et al. (2022) Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery. Spine (Phila Pa 1976) 47:986–94

  11. Iijima Y, Kotani T, Sakuma T et al (2020) Risk factors for loosening of S2 alar iliac screw: surgical outcomes of adult spinal deformity. Asian Spine J 14:864–871

    Article  PubMed  PubMed Central  Google Scholar 

  12. Nakashima H, Kanemura T, Satake K et al (2020) The prevalence and risk factors for S2 Alar-Iliac screw loosening with a minimum 2-year follow-up. Asian Spine J 14:177–184

    Article  PubMed  Google Scholar 

  13. Tateen A, Bogert J, Koller H, et al. (2018) Complications of the lumbosacral junction in adult deformity surgery: indications and technique for posterior and anterior revision surgery. Orthopade 47:320–329

  14. Krishnan V, Varghese V, Kumar GS et al (2020) Identification of pedicle screw pullout load paths for osteoporotic vertebrae. Asian Spine J 14:273–279

    Article  PubMed  PubMed Central  Google Scholar 

  15. Inagaki N, Tanaka T, Udaka J et al (2022) Distribution of Hounsfield unit values in the pelvic bones: a comparison between young men and women with traumatic fractures and older men and women with fragility fractures: a retrospective cohort study. BMC Musculoskelet Disord 23:305

    Article  PubMed  PubMed Central  Google Scholar 

  16. Liu F, Yang Y, Wen C et al (2020) Morphometric measurement and applicable feature analysis of sacral alar-iliac screw fixation using forward engineering. Arch Orthop Trauma Surg 140:177–186

    Article  PubMed  Google Scholar 

  17. Wu AM, Chi YL, Ni WF et al (2016) The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study. PeerJ 4:e1587

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jeong ST, Park YS, Jung GH (2019) Computational simulation of sacral-alar-iliac (S2AI) screw fixation of pelvis and implications for fluoroscopic procedure: a cadaver study. J Orthop Surg (Hong Kong) 27:2309499019836246

    Article  PubMed  Google Scholar 

  19. Dominic M, Markus W, Boyko G et al (2020) Computational optimisation of screw orientations for improved locking plate fixation of proximal humerus fractures. J Orthopaed Transl 25:96–104

    Article  Google Scholar 

  20. Fradet L, Bianco RJ, Tatsumi R et al (2020) Biomechanical comparison of sacral and transarticular sacroiliac screw fixation. Spine Deform 8:853–862

    Article  PubMed  Google Scholar 

  21. Bianco RJ, Arnoux PJ, Mac-Thiong JM et al (2019) Thoracic pedicle screw fixation under axial and perpendicular loadings: a comprehensive numerical analysis. Clin Biomech (Bristol, Avon) 68:190–196

    Article  PubMed  Google Scholar 

  22. Bianco RJ, Arnoux PJ, Wagnac E et al (2017) Minimizing pedicle screw pullout risks: a detailed biomechanical analysis of screw design and placement. Clin Spine Surg 30:E226–E232

    Article  PubMed  Google Scholar 

  23. Caprara S, Fasser MR, Spirig JM et al (2022) Bone density optimized pedicle screw instrumentation improves screw pull-out force in lumbar vertebrae. Comput Methods Biomech Biomed Eng 25:464–474

    Article  Google Scholar 

  24. Graham RB, Sugrue PA, Koski TR (2016) Adult degenerative scoliosis. Clin Spine Surg 29:95–107

    Article  PubMed  Google Scholar 

  25. Qiao N, Villemure I, Aubin CE (2023) A novel method for assigning bone material properties to a comprehensive patient-specific pelvic finite element model using biplanar multi-energy radiographs. Comput Methods Biomech Biomed Eng. https://doi.org/10.1080/10255842.2023.2280764

  26. Yorke AA, McDonald GC, Solis D, et al. (2019) Pelvic reference data: The Cancer Imaging Archive

  27. Riggs BL, Wahner HW, Dunn WL et al (1981) Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. J Clin Invest 67:328–335

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Dube-Cyr R, Villemure I, Arnoux PJ, et al. (2021) Instrumentation of the sacroiliac joint with cylindrical threaded implants: a detailed finite element study of patient characteristics affecting fixation performance. J Orthop Res 39(12):2693–2702

  29. Joffre T, Isaksson P, Procter P et al (2017) Trabecular deformations during screw pull-out: a micro-CT study of lapine bone. Biomech Model Mechanobiol 16:1349–1359

    Article  PubMed  PubMed Central  Google Scholar 

  30. Dube-Cyr R, Aubin CE, Villemure I et al (2020) Biomechanical analysis of two insertion sites for the fixation of the sacroiliac joint via an oblique lateral approach. Clin Biomech (Bristol, Avon) 74:118–123

    Article  PubMed  Google Scholar 

  31. Jain A, Hassanzadeh H, Strike SA et al (2015) Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone Joint Surg Am 97:1521–1528

    Article  PubMed  Google Scholar 

  32. Yilmaz E, Abdul-Jabbar A, Tawfik T et al (2018) S2 Alar-Iliac screw insertion: technical note with pictorial guide. World Neurosurg 113:e296–e301

    Article  PubMed  Google Scholar 

  33. O'Brien JR, Yu W, Kaufman BE, et al. (1976) Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation. Spine (Phila Pa) 2013;38:E1250–E1255

  34. de Winter JCF (2013) Using the Student’ s t-test with extremely small sample sizes

Download references

Acknowledgements

The authors would like to thank Christian Bellefleur, Sophie Labat and Sajjad Rastegar-Talzali for their continuous support.

Funding

The project was funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair program with Medtronic of Canada (IRCPJ 346145-16), and the Collaborative Research and Training Experience program).

Author information

Authors and Affiliations

  1. Institute of Biomedical Engineering, Polytechnique Montréal, PO Box 6079, Downtown station, Montreal, QC H3C 3A7, Canada

    Ningxin Qiao, Isabelle Villemure & Carl-Eric Aubin

  2. Sainte-Justine University Hospital Center, Montreal, Canada

    Ningxin Qiao, Isabelle Villemure & Carl-Eric Aubin

  3. Centre Hospitalier de l’Université de Montréal, Montreal, Canada

    Zhi Wang

  4. Department of Mechanical Engineering, Ecole de Technologie Supérieure, Montreal, Canada

    Yvan Petit

  5. Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Canada

    Zhi Wang & Carl-Eric Aubin

Authors
  1. Ningxin Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabelle Villemure
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yvan Petit
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carl-Eric Aubin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ningxin Qiao: Design, simulations, analysis, interpretation of the data for the work, drafting work, revising, final approbation, agree to be accountable. Isabelle Villemure: Design, interpretation of the data for the work, comprehensive review, final approbation, agree to be accountable. Zhi Wang: Interpretation of the data for the work, revising, final approbation, agree to be accountable. Yvan Petit: Interpretation of the data for the work, revising, final approbation, agree to be accountable. Carl-Eric Aubin: Design, interpretation of the data for the work, comprehensive review, final approbation, agree to be accountable.

Corresponding author

Correspondence to Carl-Eric Aubin.

Ethics declarations

Competing interests

The authors disclose academic R&D support from Medtronic (Natural Sciences and Engineering Research Council of Canada (NSERC) industrial research chair program with Medtronic of Canada) and the NSERC-CREATE program.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qiao, N., Villemure, I., Wang, Z. et al. Optimization of S2-alar-iliac screw (S2AI) fixation in adult spine deformity using a comprehensive genetic algorithm and finite element model personalized to patient geometry and bone mechanical properties. Spine Deform 12, 595–602 (2024). https://doi.org/10.1007/s43390-024-00833-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-024-00833-y

Keywords

Search

Navigation