Bilateral open sacroiliac joint fusion during adult spinal deformity surgery using triangular titanium implants: technique description and presentation of 21 cases

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  • 1 Departments of Orthopedic Surgery and
  • | 2 Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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OBJECTIVE

Pelvic fixation enhances long constructs during deformity surgery. Subsequent loosening of iliac screws and pain at the pelvis occur in as many as 29% of patients. Concomitant sacroiliac (SI) fusion may prevent potential pain and failure. The objective of this study was to describe a novel surgical technique and a single institution’s experience using bilateral SI fusion during adult deformity surgery with S2-alar-iliac (S2AI) screws and triangular titanium rods (TTRs) placed with navigation.

METHODS

The authors reviewed open SI joint fusions with TTR performed between August 2019 and March 2020. All patients underwent lumbosacral fusion through a midline approach and bilateral S2AI pelvic fixation in the caudal teardrop, followed by TTR placement just proximal and cephalad to the S2AI screws using intraoperative CT imaging guidance.

RESULTS

Twenty-one patients were identified who received 42 TTRs, ranging in size from 7.0 × 65 mm to 7.0 × 90 mm. Three TTRs (7%) were malpositioned intraoperatively, and each was successfully repositioned during index surgery without negative sequelae. All breaches occurred in a medial and cephalad direction into the pelvis. Incremental operative time for adding TTR averaged 8 minutes and 33 seconds per implant.

CONCLUSIONS

Image-guided open SI joint fusion with TTR during lumbosacral fusion is technically feasible. The bony corridor for implant placement is narrower cephalad, and implants tend to deviate medially into the pelvis. Detection of malpositioned implant is aided with intraoperative CT, but this can be salvaged. A prospective randomized clinical trial is underway that will better inform the impact of this technique on patient outcomes.

ABBREVIATIONS

S2AI = S2-alar-iliac; SI = sacroiliac; TTR = triangular titanium rod.

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Contributor Notes

Correspondence Christopher T. Martin: University of Minnesota, Minneapolis, MN. mart1865@umn.edu.

INCLUDE WHEN CITING Published online September 10, 2021; DOI: 10.3171/2021.3.SPINE202218.

Disclosures Dr. Martin is a committee member of AO Spine Knowledge Forum and receives travel expenses from Medtronic. Dr. Jones receive institutional research support from SI Bone. Dr. Sembrano receives non–study-related clinical or research support from NuVasive, Orthofix, and AO Spine. Dr. Polly is a consultant for SI Bone, receives royalties from SI Bone, holds patents with SI Bone, and receives non–study-related clinical or research support from Medtronic and Mizuho OSI.

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