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Article: Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct

TitleBiomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct
Authors
KeywordsBiomechanics
Iliac screw
Lumbo-iliac fixation
Sacral tumor
Sacrectomy
Issue Date2010
PublisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586
Citation
European Spine Journal, 2010, v. 19 n. 7, p. 1121-1128 How to Cite?
AbstractThe development of iliac screws has provided a markedly easier way for spino-pelvic instrumentation than the classical Galveston technique. However, high rates of iliac screw loosening and breakage are usually reported, especially in cases where bilateral single iliac screws are used. Therefore, there is a need for exploring more stable iliac fixation techniques. Thus, the objective of this study was to compare the biomechanical effects of bilateral single and dual iliac screws on the stability of L3-iliac fixation construct under total sacrectomy condition. In this study, L2-pelvic specimens were harvested from seven fresh human cadavers. After biomechanically testing the intact state simulated by L3-L5 pedicle screw fixation, destabilization was introduced by total sacrectomy. Upon destabilization, L3-iliac screw-rod reconstructions were performed by four different techniques as follows: (1) bilateral single short iliac screws (Single-Short); (2) bilateral single long iliac screws (Single-Long); (3) bilateral dual short iliac screws, placed in the upper and lower iliac columns (Dual-UL); and (4) bilateral dual short iliac screws, all placed in the lower iliac column (Dual-Lower). These four iliac screw fixation techniques were sequentially preformed in the same specimen, and the lengths of the short and long iliac screws were 70 and 130 mm, respectively. Biomechanical testing was performed on a material testing machine under 800 N compression and 7 Nm torsion loading modes to evaluate the construct stiffness. In compression, the stiffness of the L3-iliac fixation constructs of Single-Short, Single-Long, Dual-UL, and Dual-Lower techniques were 73, 76, 98, and 108% of the intact state, respectively. No significant differences were detected between Single-Short and Single-Long (P = 0.589) techniques. However, the compressive stiffness of these two techniques was significantly lower than the intact state, and the Dual-UL and Dual-Lower techniques (P < 0.05). There was no statistical difference between the intact condition and the Dual-Lower technique (P = 0.109). Interestingly, Dual-Lower exhibited notably higher compressive stiffness than Dual-UL (+10.3%, P = 0.049). In torsion, the stiffness of Single-Short, Single-Long, Dual-UL, and Dual-Lower techniques were 72, 79, 105, and 109% of the intact condition, respectively. No significant differences were detected between Single-Short and Single-Long techniques (P = 0.338), and also among Dual-UL, Dual-lower techniques, and the intact state (P > 0.05). However, Single-Short and Single-Long techniques provided markedly lower construct torsional stiffness than the other three groups (P < 0.05). For lumbo-illiac reconstruction after total sacrectomy, even the use of bilateral single, long iliac screws do not help in restoring the local stability to the intact condition. However, dual iliac screws provide much higher construct stability than single iliac screw techniques. Therefore, dual iliac screw technique should be preferred for treating the unstable situation caused by total sacrectomy. © 2010 Springer-Verlag.
Persistent Identifierhttp://hdl.handle.net/10722/142444
ISSN
2015 Impact Factor: 2.132
2015 SCImago Journal Rankings: 0.972
PubMed Central ID
ISI Accession Number ID
Funding AgencyGrant Number
Guangdong Provincial Medical Research Foundation of ChinaA2008161
2008B050100012
Funding Information:

The authors would like to thank Medtronic-WeiGao Inc. for providing the posterior spinal fixation system. This study was supported by Guangdong Provincial Medical Research Foundation of China (A2008161 and 2008B050100012).

References

 

DC FieldValueLanguage
dc.contributor.authorYu, BSen_HK
dc.contributor.authorZhuang, XMen_HK
dc.contributor.authorZheng, ZMen_HK
dc.contributor.authorLi, ZMen_HK
dc.contributor.authorWang, TPen_HK
dc.contributor.authorLu, WWen_HK
dc.date.accessioned2011-10-28T02:46:07Z-
dc.date.available2011-10-28T02:46:07Z-
dc.date.issued2010en_HK
dc.identifier.citationEuropean Spine Journal, 2010, v. 19 n. 7, p. 1121-1128en_HK
dc.identifier.issn0940-6719en_HK
dc.identifier.urihttp://hdl.handle.net/10722/142444-
dc.description.abstractThe development of iliac screws has provided a markedly easier way for spino-pelvic instrumentation than the classical Galveston technique. However, high rates of iliac screw loosening and breakage are usually reported, especially in cases where bilateral single iliac screws are used. Therefore, there is a need for exploring more stable iliac fixation techniques. Thus, the objective of this study was to compare the biomechanical effects of bilateral single and dual iliac screws on the stability of L3-iliac fixation construct under total sacrectomy condition. In this study, L2-pelvic specimens were harvested from seven fresh human cadavers. After biomechanically testing the intact state simulated by L3-L5 pedicle screw fixation, destabilization was introduced by total sacrectomy. Upon destabilization, L3-iliac screw-rod reconstructions were performed by four different techniques as follows: (1) bilateral single short iliac screws (Single-Short); (2) bilateral single long iliac screws (Single-Long); (3) bilateral dual short iliac screws, placed in the upper and lower iliac columns (Dual-UL); and (4) bilateral dual short iliac screws, all placed in the lower iliac column (Dual-Lower). These four iliac screw fixation techniques were sequentially preformed in the same specimen, and the lengths of the short and long iliac screws were 70 and 130 mm, respectively. Biomechanical testing was performed on a material testing machine under 800 N compression and 7 Nm torsion loading modes to evaluate the construct stiffness. In compression, the stiffness of the L3-iliac fixation constructs of Single-Short, Single-Long, Dual-UL, and Dual-Lower techniques were 73, 76, 98, and 108% of the intact state, respectively. No significant differences were detected between Single-Short and Single-Long (P = 0.589) techniques. However, the compressive stiffness of these two techniques was significantly lower than the intact state, and the Dual-UL and Dual-Lower techniques (P < 0.05). There was no statistical difference between the intact condition and the Dual-Lower technique (P = 0.109). Interestingly, Dual-Lower exhibited notably higher compressive stiffness than Dual-UL (+10.3%, P = 0.049). In torsion, the stiffness of Single-Short, Single-Long, Dual-UL, and Dual-Lower techniques were 72, 79, 105, and 109% of the intact condition, respectively. No significant differences were detected between Single-Short and Single-Long techniques (P = 0.338), and also among Dual-UL, Dual-lower techniques, and the intact state (P > 0.05). However, Single-Short and Single-Long techniques provided markedly lower construct torsional stiffness than the other three groups (P < 0.05). For lumbo-illiac reconstruction after total sacrectomy, even the use of bilateral single, long iliac screws do not help in restoring the local stability to the intact condition. However, dual iliac screws provide much higher construct stability than single iliac screw techniques. Therefore, dual iliac screw technique should be preferred for treating the unstable situation caused by total sacrectomy. © 2010 Springer-Verlag.en_HK
dc.languageengen_US
dc.publisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586en_HK
dc.relation.ispartofEuropean Spine Journalen_HK
dc.rightsThe original publication is available at www.springerlink.com-
dc.subjectBiomechanicsen_HK
dc.subjectIliac screwen_HK
dc.subjectLumbo-iliac fixationen_HK
dc.subjectSacral tumoren_HK
dc.subjectSacrectomyen_HK
dc.subject.meshBiomechanics-
dc.subject.meshBone Screws-
dc.subject.meshFracture Fixation, Internal - instrumentation - methods-
dc.subject.meshIlium - surgery-
dc.subject.meshLumbar Vertebrae - surgery-
dc.titleBiomechanical advantages of dual over single iliac screws in lumbo-iliac fixation constructen_HK
dc.typeArticleen_HK
dc.identifier.emailLu, WW:wwlu@hku.hken_HK
dc.identifier.authorityLu, WW=rp00411en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1007/s00586-010-1343-8en_HK
dc.identifier.pmid20195650-
dc.identifier.pmcidPMC2900011-
dc.identifier.scopuseid_2-s2.0-77954543111en_HK
dc.identifier.hkuros197078en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77954543111&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume19en_HK
dc.identifier.issue7en_HK
dc.identifier.spage1121en_HK
dc.identifier.epage1128en_HK
dc.identifier.isiWOS:000279502600010-
dc.publisher.placeGermanyen_HK
dc.identifier.scopusauthoridYu, BS=25633299000en_HK
dc.identifier.scopusauthoridZhuang, XM=35436325900en_HK
dc.identifier.scopusauthoridZheng, ZM=7403007434en_HK
dc.identifier.scopusauthoridLi, ZM=36168413000en_HK
dc.identifier.scopusauthoridWang, TP=36554866000en_HK
dc.identifier.scopusauthoridLu, WW=7404215221en_HK
dc.identifier.citeulike6807447-

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