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

MedStar author(s):
Citation: Journal of Neurosurgery Spine. :1-9, 2019 Jan 04PMID: 30611149Department: Medstar Union Memorial HospitalForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2019Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 1547-5646
Name of journal: Journal of neurosurgery. SpineAbstract: OBJECTIVEThe objective of the current study was to quantify and compare the multidirectional flexibility properties of sacral alar iliac fixation with conventional methods of sacral and sacroiliac fixation by using nondestructive and destructive investigative methods.METHODSTwenty-one cadaveric lumbopelvic spines were randomized into 3 groups based on reconstruction conditions: 1) S1-2 sacral screws; 2) sacral alar iliac screws; and 3) S1-iliac screws tested under unilateral and bilateral fixation. Nondestructive multidirectional flexibility testing was performed using a 6-degree- of-freedom spine simulator with moments of +/- 12.5 Nm. Flexion- extension fatigue loading was then performed for 10,000 cycles, and the multidirectional flexibility analysis was repeated. Final destructive testing included an anterior flexural load to construct failure. Quantification of the lumbosacral and sacroiliac joint range of motion was normalized to the intact spine (100%), and flexural failure loads were reported in Newton-meters.RESULTSNormalized value comparisons between the intact spine and the 3 reconstruction groups demonstrated significant reductions in segmental flexion-extension, lateral bending, and axial rotation motion at L4-5 and L5-S1 (p < 0.05). The S1-2 sacral reconstruction group demonstrated significantly greater flexion-extension motion at the sacroiliac junction than the intact and comparative reconstruction groups (p < 0.05), whereas the sacral alar iliac group demonstrated significantly less motion at the sacroiliac joint in axial rotation (p < 0.05). Absolute value comparisons demonstrated similar findings. Under destructive anterior flexural loading, the S1-2 sacral group failed at 105 +/- 23 Nm, and the sacral alar iliac and S1-iliac groups failed at 119 +/- 39 Nm and 120 +/- 28 Nm, respectively (p > 0.05).CONCLUSIONSAlong with difficult anatomy and weak bone, the large lumbosacral loads with cantilever pullout forces in this region are primary reasons for construct failure. All reconstructions significantly reduced flexibility at the L5-S1 junctions, as expected. Conventional S1-2 sacral fixation significantly increased sacroiliac motion under all loading modalities and demonstrated significantly higher flexion-extension motion than all other groups, and sacral alar iliac fixation reduced motion in axial rotation at the sacroiliac joint. Based on comprehensive multidirectional flexibility testing, the sacral alar iliac fixation technique reduced segmental motion under some loading modalities compared to S1-iliac screws and offers potential advantages of lower instrumentation profile and ease of assembly compared to conventional sacroiliac instrumentation techniques.All authors: Cunningham BW, Kikkawa J, Murgatroyd AA, Sponseller PD, Tortolani PJFiscal year: FY2019Digital Object Identifier: Date added to catalog: 2019-01-18
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30611149 Available 30611149

Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006

OBJECTIVEThe objective of the current study was to quantify and compare the multidirectional flexibility properties of sacral alar iliac fixation with conventional methods of sacral and sacroiliac fixation by using nondestructive and destructive investigative methods.METHODSTwenty-one cadaveric lumbopelvic spines were randomized into 3 groups based on reconstruction conditions: 1) S1-2 sacral screws; 2) sacral alar iliac screws; and 3) S1-iliac screws tested under unilateral and bilateral fixation. Nondestructive multidirectional flexibility testing was performed using a 6-degree- of-freedom spine simulator with moments of +/- 12.5 Nm. Flexion- extension fatigue loading was then performed for 10,000 cycles, and the multidirectional flexibility analysis was repeated. Final destructive testing included an anterior flexural load to construct failure. Quantification of the lumbosacral and sacroiliac joint range of motion was normalized to the intact spine (100%), and flexural failure loads were reported in Newton-meters.RESULTSNormalized value comparisons between the intact spine and the 3 reconstruction groups demonstrated significant reductions in segmental flexion-extension, lateral bending, and axial rotation motion at L4-5 and L5-S1 (p < 0.05). The S1-2 sacral reconstruction group demonstrated significantly greater flexion-extension motion at the sacroiliac junction than the intact and comparative reconstruction groups (p < 0.05), whereas the sacral alar iliac group demonstrated significantly less motion at the sacroiliac joint in axial rotation (p < 0.05). Absolute value comparisons demonstrated similar findings. Under destructive anterior flexural loading, the S1-2 sacral group failed at 105 +/- 23 Nm, and the sacral alar iliac and S1-iliac groups failed at 119 +/- 39 Nm and 120 +/- 28 Nm, respectively (p > 0.05).CONCLUSIONSAlong with difficult anatomy and weak bone, the large lumbosacral loads with cantilever pullout forces in this region are primary reasons for construct failure. All reconstructions significantly reduced flexibility at the L5-S1 junctions, as expected. Conventional S1-2 sacral fixation significantly increased sacroiliac motion under all loading modalities and demonstrated significantly higher flexion-extension motion than all other groups, and sacral alar iliac fixation reduced motion in axial rotation at the sacroiliac joint. Based on comprehensive multidirectional flexibility testing, the sacral alar iliac fixation technique reduced segmental motion under some loading modalities compared to S1-iliac screws and offers potential advantages of lower instrumentation profile and ease of assembly compared to conventional sacroiliac instrumentation techniques.

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