Biomechanical analysis of two insertion sites for the fixation of the sacroiliac joint via an oblique lateral approach.
Arthrodesis
Biomechanics
Minimally invasive surgery
Sacroiliac joint
Sacroiliac joint fixation
Sacroiliac joint fusion
Journal
Clinical biomechanics (Bristol, Avon)
ISSN: 1879-1271
Titre abrégé: Clin Biomech (Bristol, Avon)
Pays: England
ID NLM: 8611877
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
27
11
2019
revised:
12
02
2020
accepted:
17
02
2020
pubmed:
21
3
2020
medline:
20
2
2021
entrez:
21
3
2020
Statut:
ppublish
Résumé
The sacroiliac joint is an important source of low back pain. In severe cases, sacroiliac joint fusion is used to reduce pain, but revision rates can reach 30%. The lack of initial mechanical stability may lead to pseudarthrosis, thus not alleviating the patient's symptoms. This could be due to the damage induced to the interosseous ligament during implant insertion. Decoupling instrumentation steps (drilling-tapping and implant insertion) would allow verifying this hypothesis. Moreover, no biomechanical studies have been published on sacroiliac joint fixation with an oblique lateral approach, while it has important clinical advantages over the direct lateral approach. Eight cadaveric human pelves with both ischia embedded were tested in three sequential states: intact, drilled-tapped and instrumented with one cylindrical threaded implant with an oblique lateral trajectory. Specimens were assigned one of two insertion sites (distal point; near the posterior superior iliac spine, and proximal point; anterosuperior to the distal point) and tested in compression and flexion-extension. Vertical and angular displacements of the sacroiliac joint were measured locally using digital image correlation methods. In compression, instrumentation significantly reduced vertical displacements (17% (SD 22%), P = 0.04) but no difference was found for angular displacements or flexion-extension loads (P > 0.05). Drilling-tapping did not change the stability of the sacroiliac joint (P > 0.05); there was no statistical difference between the insertion sites (P > 0.05). Insertion of one implant through either the distal or proximal insertion site with an oblique lateral approach significantly reduced vertical displacements of the sacroiliac joint in compression, a predominant load of this joint. Polytechnique Montreal: CÉR-1617-30.
Sections du résumé
BACKGROUND
The sacroiliac joint is an important source of low back pain. In severe cases, sacroiliac joint fusion is used to reduce pain, but revision rates can reach 30%. The lack of initial mechanical stability may lead to pseudarthrosis, thus not alleviating the patient's symptoms. This could be due to the damage induced to the interosseous ligament during implant insertion. Decoupling instrumentation steps (drilling-tapping and implant insertion) would allow verifying this hypothesis. Moreover, no biomechanical studies have been published on sacroiliac joint fixation with an oblique lateral approach, while it has important clinical advantages over the direct lateral approach.
METHODS
Eight cadaveric human pelves with both ischia embedded were tested in three sequential states: intact, drilled-tapped and instrumented with one cylindrical threaded implant with an oblique lateral trajectory. Specimens were assigned one of two insertion sites (distal point; near the posterior superior iliac spine, and proximal point; anterosuperior to the distal point) and tested in compression and flexion-extension. Vertical and angular displacements of the sacroiliac joint were measured locally using digital image correlation methods.
FINDINGS
In compression, instrumentation significantly reduced vertical displacements (17% (SD 22%), P = 0.04) but no difference was found for angular displacements or flexion-extension loads (P > 0.05). Drilling-tapping did not change the stability of the sacroiliac joint (P > 0.05); there was no statistical difference between the insertion sites (P > 0.05).
INTERPRETATIONS
Insertion of one implant through either the distal or proximal insertion site with an oblique lateral approach significantly reduced vertical displacements of the sacroiliac joint in compression, a predominant load of this joint.
RESEARCH ETHICS COMMITTEE
Polytechnique Montreal: CÉR-1617-30.
Identifiants
pubmed: 32192993
pii: S0268-0033(20)30074-7
doi: 10.1016/j.clinbiomech.2020.02.010
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
118-123Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Medtronic provided the implants and surgical kit for the study. Carl-Éric Aubin – Funding: Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair program with Medtronic of Canada) (grant number PCIPJ-346145). Development grant from Medtronic Canada (outside of the subject of the manuscript). The other authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.