A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model

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In Brief

In this in vitro investigation, we compared the multidirectional flexibility properties of sacral alar iliac fixation with conventional methods of sacral and sacroiliac fixation using nondestructive and destructive investigative methods. The study demonstrated that S1–2 sacral fixation alone significantly increases sacroiliac motion under all loading modalities, while sacral alar iliac fixation reduced motion in axial rotation at the sacroiliac joint and offers potential advantages of a lower instrumentation profile and ease of assembly compared to conventional sacroiliac screw instrumentation.

ABBREVIATIONS ROM = range of motion.

Article Information

Correspondence Bryan W. Cunningham: Musculoskeletal Education and Research Institute, MedStar Union Memorial Hospital, Baltimore, MD. bryan.w.cunningham@medstar.net.

INCLUDE WHEN CITING Published online January 4, 2019; DOI: 10.3171/2018.8.SPINE18328.

Disclosures Dr. Cunningham reports receiving clinical or research support for the study from DePuy Synthes Spine, Inc. Dr. Sponseller reports receiving research support and royalties from DePuy Synthes Spine, Inc., and royalties from Globus Medical. Dr. Tortolani reports receiving royalties, payment for the sale of intellectual properties, and fellowship grant support from Globus Medical, Innovasis, and KM2, as well as a clinical research grant and royalties from Spineology; he is also a consultant for Innovasis.

Monetary grant research support and instrumentation were provided by DePuy Synthes Spine, Inc. Grant support was provided by Advanced Spinal Technology, LLC.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Anterolateral view of an intact lumbopelvic specimen prepared for biomechanical testing, demonstrating the position of the 6 optoelectronic marker grids.

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    Posterior views of the 4 reconstruction groups tested: S1–2 screws (A), sacral alar iliac screws (B), S1–iliac screws with unilateral fixation (C), and S1–iliac screws with bilateral fixation (D).

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    Flexion-extension ROM. Comparisons of the intact spine and 4 subsequent pre- and postfatigue reconstruction conditions demonstrated significant reductions in segmental L5–S1 operative level motion (p < 0.05). The sacroiliac joint (SIJ) ROM for S1–2 screw reconstruction was significantly greater than all other treatments prefatigue (*p < 0.05) and for all groups postfatigue except S1–iliac bilateral (**p < 0.05). Bar height represents mean values and error bars represent minus one SD. All values are normalized to the intact condition (100%) and statistical difference indicated at p < 0.05.

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    Lateral bending ROM. Comparisons of the intact spine and 4 subsequent pre- and postfatigue reconstruction conditions demonstrated significant reductions in segmental L5–S1 operative level motion (p < 0.05). No other comparisons were significant. Bar height represents mean values and error bars represent minus one SD. All values are normalized to the intact condition (100%) and statistical difference indicated at p < 0.05. NSS = no statistical significance.

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    Axial rotation ROM. Comparisons of the intact spine and 4 subsequent reconstruction conditions demonstrated significant reductions in segmental L5–S1 operative level motion for the S1–2 sacral and sacral alar iliac groups both pre- and postfatigue (p < 0.05). Prefatigue, the sacroiliac joint ROM for the sacral alar iliac screw reconstruction was significantly less than those of the S1–2 sacral and S1–iliac bilateral fixation groups (p < 0.05). Postfatigue, the sacral alar iliac screw group ROM was significantly less than that of the S1–2 sacral group (p < 0.05). Bar height represents mean values and error bars represent minus one SD. All values are normalized to the intact condition (100%) and statistical difference indicated at p < 0.05.

  • View in gallery

    Destructive testing failure mechanism. A: Posterior view of an S1–2 screw construct that failed through direct pullout of the S1 and S2 screws. B: Posterior view of a sacral alar iliac screw construct that failed by fracture of the left iliac wing itself.

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