From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Sherif, Dr. Zapolsky, Dr. Falk, and Dr. Arlet); the Texas A&M College of Medicine, Bryan, TX (Mr. Ling); Department of Orthopedics and Sports Medicine Houston Methodist Hospital, Houston, TX (Dr. Bondar andDr. Saifi).
J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 16;7(8). doi: 10.5435/JAAOSGlobal-D-22-00251. eCollection 2023 Aug 1.
Patients with adult spinal deformity (ASD) may have risk factors for nonunion and subsequent instrumentation failure. This study reviews a novel surgical technique for a quad-rod construct to the pelvis using both S2 alar iliac (S2AI) screw fixation and medialized entry iliac screw fixation as described through three separate cases and a review of the literature.
This technique facilitates alignment of the construct and rod insertion into the tulip heads. The medialized iliac screw technique also avoids the potential soft-tissue complications of the conventional iliac screw bolt given that it is deeper and has more soft-tissue coverage.
Three cases performed by the most senior author (V.A.) in which this novel technique was used are presented in this report along with clinical and radiographic images to educate the reader on appropriate execution of this technique. A review of the existing literature regarding pelvic fixation techniques for ASD was also done.
Quad-rod augmentation of long thoracolumbar spinal constructs with two independent SI anchoring points is potentially an effective technique to increase lumbar sacral construct rigidity, thereby promoting fusion rates and decreasing revision rates. The described technique provides spine surgeons with an additional tool in their armamentarium to treat patients with complex ASD.
成人脊柱畸形（ASD）患者可能存在非融合和随后器械失败的风险因素。本研究通过三个单独的病例和文献复习，回顾了一种使用 S2 骼骨翼（S2AI）螺钉固定和内侧入路骼骨螺钉固定的新型四杆骨盆结构的手术技术。
该技术有利于构建物的对准和将杆插入郁金香头。内侧入路骼骨螺钉技术还避免了传统骼骨螺钉螺栓的潜在软组织并发症，因为它更深，有更多的软组织覆盖。
报告介绍了由最资深的作者（VA）进行的三个病例，使用了这种新的技术，并提供了临床和影像学图像，以教育读者如何正确执行该技术。还对 ASD 骨盆固定技术的现有文献进行了回顾。
通过两个独立的 SI 锚固点增强长胸腰椎脊柱结构的四杆增强，可能是一种有效的技术，可以增加腰骶部结构刚性，从而提高融合率，降低翻修率。所描述的技术为脊柱外科医生提供了一种额外的工具，用于治疗复杂的 ASD 患者。
