PT  - JOURNAL ARTICLE
AU  - Matteo Panico
AU  - Ruchi D. Chande
AU  - Derek P. Lindsey
AU  - Ali Mesiwala
AU  - David W. Polly
AU  - Tomaso Villa
AU  - Scott A. Yerby
AU  - Marco Brayda-Bruno
AU  - Fabio Galbusera
TI  - Stability and Instrumentation Stresses Among Sacropelvic Fixation Techniques With Novel Porous Fusion/Fixation Implants: A Finite Element Study
AID  - 10.14444/8481
DP  - 2023 Aug 01
TA  - International Journal of Spine Surgery
PG  - 598--606
VI  - 17
IP  - 4
4099  - https://www.ijssurgery.com/content/17/4/598.short
4100  - https://www.ijssurgery.com/content/17/4/598.full
SO  - Int J Spine Surg2023 Aug 01; 17
AB  - Background Sacropelvic fixation is frequently combined with thoracolumbar instrumentation for correcting spinal deformities. This study aimed to characterize sacropelvic fixation techniques using novel porous fusion/fixation implants (PFFI).Methods Three T10-pelvis finite element models were created: (1) pedicle screws and rods in T10-S1, PFFI bilaterally in S2 alar-iliac (S2AI) trajectory; (2) fixation in T10-S1, PFFI bilaterally in S2AI trajectory, triangular implants bilaterally above the PFFI in a sacro-alar-iliac trajectory (PFFI-IFSAI); and (3) fixation in T10-S1, PFFI bilaterally in S2AI trajectory, PFFI in sacro-alar-iliac trajectory stacked cephalad to those in S2AI position (2-PFFI). Models were loaded with pure moments of 7.5 Nm in flexion-extension, lateral bending, and axial rotation. Outputs were compared against 2 baseline models: (1) pedicle screws and rods in T10-S1 (PED), and (2) pedicle screws and rods in T10-S1, and S2AI screws.Results PFFI and S2AI resulted in similar L5-S1 motion; adding another PFFI per side (2-PFFI) further reduced this motion. Sacroiliac joint (SIJ) motion was also similar between PFFI and S2AI; PFFI-IFSAI and 2-PFFI demonstrated a further reduction in SIJ motion. Additionally, PFFI reduced max stresses on S1 pedicle screws and on implants in the S2AI position.Conclusion The study shows that supplementing a long construct with PFFI increases the stability of the L5-S1 and SIJ and reduces stresses on the S1 pedicle screws and implants in the S2AI position.Clinical Relevance The findings suggest a reduced risk of pseudarthrosis at L5-S1 and screw breakage. Clinical studies may be performed to demonstrate applicability to patient outcomes.Level of Evidence Not applicable (basic science study).