S2 alar-iliac screw versus traditional iliac screw for spinopelvic fixation: a systematic review of comparative biomechanical studies

Takashi Hirase, Caleb Shin, Jeremiah Ling, Brian Phelps, Varan Haghshenas, Comron Saifi, Darrell S. Hanson

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations

Abstract

Purpose: To review and compare biomechanical properties between S2 alar-iliac (S2AI) screws and traditional iliac screws for spinopelvic fixation. Methods: A systematic review was performed according to PRISMA guidelines. All clinical, cadaveric, and finite-element model (FEM) studies that compared the biomechanical properties between S2AI screws and traditional iliac screws were included. Study methodological quality for cadaveric studies were analyzed using the Quality Appraisal for Cadaveric Studies (QUACS) scale. Results: Eight studies (4 cadaveric, 4 FEM) analyzing 58 S2AI screws and 48 traditional iliac screws were included. According to QUACS, the overall methodological quality was “moderate to good” for all four cadaveric studies. All four cadaveric studies found no difference in biomechanical stiffness, screw toggle, rod strain, and/or load-to-failure between the S2AI screws and traditional iliac screws for spinopelvic fixation. All four FEM studies found that S2AI screws were associated with lower implant stresses compared to traditional iliac screws. Conclusions: There is moderate biomechanical evidence to suggest that there is no significant difference in stability and stiffness between S2AI screws and traditional iliac screws for spinopelvic fixation. However, there is some evidence to support that the placement of S2AI screws may have lower implant stresses on the overall lumbosacral instrumentation compared to traditional iliac screws.

Original languageEnglish (US)
Pages (from-to)1279-1288
Number of pages10
JournalSpine Deformity
Volume10
Issue number6
DOIs
StatePublished - Nov 2022

Keywords

  • Biomechanical
  • Deformity
  • Iliac screws
  • S2 alar-iliac screws
  • Spinopelvic fixation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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