Iliac screws used in long instrumentation for deformity treatment are subject to large forces, which may sometimes lead to fixation failures (intra- and postoperatively). The objective of this study was to analyze the biomechanics of iliac screw fixations. The study was based on a patient-specific simulation of a neuromuscular scoliosis case with a long instrumentation to the pelvis. A multi body flexible model was created using a preoperative 3D reconstructed spine and pelvis. The side bending radiographs were used to personalize the mechanical properties. The instrumentation construct was modeled as rigid bodies and flexible beams connected by kinematic joints. Three instrumentation parameters were studied: the connector length, the inter rod connectors and the use of sacral screws. The simulations showed that the forces and torques at the iliac screws were lowered by 9% and 25% respectively by reducing the lateral connector length (from 20 to 10 mm). An inter rod connector did not significantly reduce the iliac screw loads. Sacral screws reduced the functional loads on the iliac screws, but hardware related problems may be shifted onto the sacral screws. Sacral screws in conjunction with inter rod connectors reduced the loads at iliac screws without overloading the sacral screws. The preliminary results showed that the forces at the iliac screws could be lowered through different instrumentation parameters. In the next step of the study, the model validation will be further completed and used to evaluate other instrumentation factors by means of an experimental design framework. The knowledge of loading biomechanics at the iliac screw fixation is important for finding solutions to reduce the risk of failure, such as improving preoperative planning, instrumentation techniques and iliac screw construct design.
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