Methods of internal sacroiliac fixation – Literature review and case series analysis of iliac screw fixation
DOI:
https://doi.org/10.6016/ZdravVestn.3222Keywords:
spine deformity, pseudoarthrosis, lumbosacral junction, iliac screw, S2-alar-iliac screwAbstract
In order to achieve bone fusion between the mobile lumbar spine and the immobile sacrum, surgical techniques have been developed along with the development of instrumentation systems for internal fixation of the thoracolumbar spine that allows the extension and fixation of such systems to the structural elements of the pelvis. The term sacroiliac fixation encompasses all instrumentation systems and surgical techniques for fixation of the lumbosacral spine to the ilium. Nowadays, prevention of pseudarthrosis of the bone fusion at the lumbosacral region, the border between two different structures (mobile lumbar spine and static pelvic ring), is one of the main challenges of surgical treatment of adult lumbar spine deformities. Biomechanically, the lumbosacral junction represents an axis of rotation extending in the lateral plane through the posterior longitudinal ligament at the height of the intervertebral disc of the moving segment L5-S1. The flexion torque arm’s size depends on the number of instrumented movable spine segments. Counter-torque is required for system stability, which, due to the short lever arm, depends mainly on the implant’s attachment strength to the pelvic ring’s bony elements. Sacroiliac fixation systems prevent the formation of pseudoarthrosis of the bone fusion of the lumbosacral junction. Its occurrence, with the exclusion of biological causes (i.e., infection), depends solely on the strength of the instrumentation system (the brittleness of the material) and the quality of attachment of the instrumentation to the pelvic ring (loss of fixation at the bone-implant interface).
Indications for sacroiliac fixation are lumbosacral fusion above the third lumbar vertebra, osteotomies of the lumbar vertebra, fractures of the sacrum with spinopelvic dissociation, partial or complete sacrectomy, lumbosacral fusion in the face of osteoporotic bone, spondylolisthesis grade III or more of Meyerding classification, correction of kyphotic or scoliotic deformity of the lumbar spine and pelvic obliquity in the frontal plane in neuromuscular deformities of the lumbar spine.
This review article aims to describe the spinopelvic junction’s biomechanics, present the developmental history of implants and surgical techniques, and describe the modern sacroiliac fixation methods.
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