A biomechanical investigation of the sacroiliac joint in the setting of lumbosacral fusion: impact of pelvic fixation versus sacroiliac joint fixation

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OBJECTIVE

The sacroiliac joint (SIJ) is a known source of low-back pain. Randomized clinical trials support sacroiliac fusion over conservative management for SIJ dysfunction. Clinical studies suggest that SIJ degeneration occurs in the setting of lumbosacral fusions. However, there are few biomechanical studies to provide a good understanding of the effect of lumbosacral fusion on the SIJ. In the present study, researchers performed a biomechanical investigation to discern the effect of pelvic versus SIJ fixation on the SIJ in lumbosacral fusion.

METHODS

Seven fresh-frozen human cadaveric specimens were used. There was one intact specimen and six operative constructs: 1) posterior pedicle screws and rods from T10 to S1 (PS); 2) PS + bilateral iliac screw fixation (BIS); 3) PS + unilateral iliac screw fixation (UIS); 4) PS + UIS + 3 contralateral unilateral SIJ screws (UIS + 3SIJ); 5) PS + 3 unilateral SIJ screws (3SIJ); and 6) PS + 6 bilateral SIJ screws (6SIJ). A custom-built 6 degrees-of-freedom apparatus was used to simulate three bending modes: flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Range of motion (ROM) was recorded at L5–S1 and the SIJ.

RESULTS

All six operative constructs had significantly reduced ROM at L5–S1 in all three bending modes compared to that of the intact specimen (p < 0.05). In the FE mode, the BIS construct had a significant reduction in L5–S1 ROM as compared to the other five constructs (p < 0.05). SIJ ROM was greatest in the FE mode compared to LB and AR. Although the FE mode did not show any statistically significant differences in SIJ ROM across the constructs, there were appreciable differences. The PS construct had the highest SIJ ROM. The BIS construct reduced bilateral SIJ ROM by 44% in comparison to the PS construct. The BIS and 6SIJ constructs showed reductions in SIJ ROM nearly equal to those of the PS construct. UIS and 3SIJ showed an appreciable reduction in unfused SIJ ROM compared to PS.

CONCLUSIONS

This investigation demonstrated the effects of various fusion constructs using pelvic and sacroiliac fixation in lumbosacral fusion. This study adds biomechanical evidence of adjacent segment stress in the SIJ in fusion constructs extending to S1. Unilateral pelvic fixation, or SIJ fusion, led to an appreciable but nonsignificant reduction in the ROM of the unfused contralateral SIJ. Bilateral pelvic fixation showed the greatest significant reduction of movement at L5–S1 and was equivalent to bilateral sacroiliac fusion in reducing SIJ motion.

ABBREVIATIONS AR = axial rotation; FE = flexion-extension; LB = lateral bending; ROM = range of motion; SIJ = sacroiliac joint; SIJF = SIJ fusion.

Article Information

Correspondence Charles A. Sansur: University of Maryland School of Medicine, Baltimore, MD. csansur@som.umaryland.edu.

INCLUDE WHEN CITING Published online June 14, 2019; DOI: 10.3171/2019.3.SPINE181127.

Disclosures Mr. Ferrick is a visiting research intern and is compensated hourly by Globus Medical Inc. (GMI). Dr. Sansur is a consultant for GMI, Stryker, and Medtronic and has received research support from GMI for the study described. Cadaveric specimens and related materials were provided by GMI, where D.M.B., G.M.H., and B.S.B. are full-time employees.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Six tested constructs: posterior pedicle screws and rods from T10 to S1 (PS); PS + unilateral iliac screw fixation (UIS); PS + bilateral iliac screw fixation (BIS); PS + UIS + contralateral 3 unilateral SIJ screws (UIS + 3SIJ); PS + 3 unilateral SIJ screws (3SIJ); and PS + 6 bilateral SIJ screws (6SIJ). Figure is available in color online only.

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    A custom-built 6 degrees-of-freedom testing apparatus with markers at L5, S1, and the left and right iliac wings. Figure is available in color online only.

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    Mean ROM at L5–S1 for all operative constructs and the intact condition. Figure is available in color online only.

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    Mean ROM in the left and right SIJs in FE for all operative constructs normalized to the PS construct (PS = 100% ROM). Figure is available in color online only.

  • View in gallery

    Mean ROM in the left and right SIJs in LB for all operative constructs normalized to the PS construct (PS = 100% ROM). Figure is available in color online only.

  • View in gallery

    Mean ROM in the left and right SIJs in AR for all operative constructs normalized to the PS construct (PS = 100% ROM). Figure is available in color online only.

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