Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw : Technical Case Series

  • Choi, Ho Yong (Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Hyun, Seung-Jae (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jahng, Tae-Ahn (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Hyun-Jib (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2016.12.29
  • Accepted : 2017.04.11
  • Published : 2018.01.01
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Abstract

Objective : Among the various sacropelvic fixation methods, S2 alar-iliac (S2AI) screw fixation has several advantages compared to conventional iliac wing screw. However, the placement of S2AI screw still remains a challenge. The purpose of this study was to describe a novel technique of free hand S2AI screw insertion using a K-wire and cannulated screw, and to evaluate the accuracy of the technique. Methods : S2AI screw was inserted by free hand technique in sixteen consecutive patients without any fluoroscopic guidance. The gearshift was advanced to make a pilot hole passing through the sacroiliac joint and directing the anterior inferior iliac spine. A K-wire was placed through the pilot hole. After introducing a cannulated tapper along with the K-wire, a cannulated S2AI screw was installed over the K-wire. Results : Thirty-three S2AI screws were placed in sixteen consecutive patients. Thirty-two screws were cannulated screws, and one screw was a conventional non-cannulated screw. Thirty out of 32 (93.8%) cannulated screws were accurately positioned, whereas two cannulated screws and one non-cannulated screw violated lateral cortex of the ilium. Conclusion : The technique using K-wire and cannulated screw can provide accurate placement of free hand S2AI screw.

Keywords

References

  1. Balderston RA, Winter RB, Moe JH, Bradford DS, Lonstein JE : Fusion to the sacrum for nonparalytic scoliosis in the adult. Spine (Phila Pa 1976) 11 : 824-829, 1986 https://doi.org/10.1097/00007632-198610000-00017
  2. Chang TL, Sponseller PD, Kebaish KM, Fishman EK : Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976) 34 : 436-440, 2009 https://doi.org/10.1097/BRS.0b013e318194128c
  3. Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS : Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976) 27 : 776-786, 2002 https://doi.org/10.1097/00007632-200204010-00017
  4. Erkan S, Hsu B, Wu C, Mehbod AA, Perl J, Transfeldt EE : Alignment of pedicle screws with pilot holes: can tapping improve screw trajectory in thoracic spines? Eur Spine J 19 : 71-77, 2010 https://doi.org/10.1007/s00586-009-1063-0
  5. Hyun SJ, Kim KJ, Jahng TA, Kim HJ : Efficiency of lead aprons in blocking radiation - how protective are they? Heliyon 2 : e00117, 2016 https://doi.org/10.1016/j.heliyon.2016.e00117
  6. Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM : Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone Joint Surg Am 97 : 1521-1528, 2015 https://doi.org/10.2106/JBJS.O.00576
  7. Kebaish KM : Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976) 35 : 2245-2251, 2010 https://doi.org/10.1097/BRS.0b013e3181f5cfae
  8. Kim YJ, Bridwell KH, Lenke LG, Cho KJ, Edwards CC 2nd, Rinella AS : Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg Am 88 : 721-728, 2006
  9. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD : Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976) 29 : 333-342; discussion 342, 2004 https://doi.org/10.1097/01.BRS.0000109983.12113.9B
  10. Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, et al. : Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26 : 1976-1983, 2001 https://doi.org/10.1097/00007632-200109150-00007
  11. Lehman RA, Potter BK, Kuklo TR, Chang AS, Polly DW, Shawen SB, et al. : Probing for thoracic pedicle screw tract violation(s): is it valid? J Spinal Disord Tech 17 : 277-283, 2004 https://doi.org/10.1097/01.bsd.0000095399.27687.c5
  12. Martin CT, Witham TF, Kebaish KM : Sacropelvic fixation: two case reports of a new percutaneous technique. Spine (Phila Pa 1976) 36 : E618-E621, 2011 https://doi.org/10.1097/BRS.0b013e3181f79aba
  13. Nottmeier EW, Pirris SM, Balseiro S, Fenton D : Three-dimensional image-guided placement of S2 alar screws to adjunct or salvage lumbosacral fixation. Spine J 10 : 595-601, 2010 https://doi.org/10.1016/j.spinee.2010.03.023
  14. O'Brien JR, Yu WD, Bhatnagar R, Sponseller P, Kebaish KM : An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976) 34 : E439-E442, 2009 https://doi.org/10.1097/BRS.0b013e3181a4e3e4
  15. Park JH, Hyun SJ, Kim KJ, Jahng TA : Free hand insertion technique of S2 sacral alar-iliac screws for spino-pelvic fixation: technical note, acadaveric study. J Korean Neurosurg Soc 58 : 578-581, 2015 https://doi.org/10.3340/jkns.2015.58.6.578
  16. Schwend RM, Sluyters R, Najdzionek J : The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976) 28 : 542-547, 2003
  17. Sponseller PD, Zimmerman RM, Ko PS, Pull Ter Gunne AF, Mohamed AS, Chang TL, et al. : Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine (Phila Pa 1976) 35 : 1887-1892, 2010 https://doi.org/10.1097/BRS.0b013e3181e03881
  18. Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C : Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976) 31 : 303-308, 2006 https://doi.org/10.1097/01.brs.0000197193.81296.f1
  19. Wind JJ, Burke LM, Kurtom KH, Roberti F, O'Brien JR : Minimally invasive lumbopelvic instrumentation for traumatic sacrolisthesis in an elderly patient. Eur Spine J 21 Suppl 4 : S549-S553, 2012 https://doi.org/10.1007/s00586-012-2204-4
  20. Zhu F, Bao HD, Yuan S, Wang B, Qiao J, Zhu ZZ, et al. : Posterior second sacral alar iliac screw insertion: anatomic study in a Chinese population. Eur Spine J 22 : 1683-1689, 2013 https://doi.org/10.1007/s00586-013-2734-4

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