ArticleJournal of neurosurgery. Case lessons2026
Contralateral screw loosening of through-and-through fixation following unilateral sacroiliac joint fusion: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundSacroiliac (SI) joint dysfunction is a frequently underrecognized source of low back pain, implicated in 15%-30% of cases across select populations. Unilateral SI joint fusion remains the most commonly performed technique, utilizing either iliosacral screws or, more recently, through-and-through (TNT) screws. OBSERVATIONS: A 65-year-old woman with a history of failed right-sided SI joint fusion underwent revision surgery with bilateral TNT screw fixation due to worsening symptoms. Follow-up imaging confirmed solid right-sided arthrodesis. However, progressive haloing and sclerosis were observed around the left iliac portion of the cephalad screw. LESSONS: This case represents the first reported instance of persistent motion and screw haloing using TNT screw fixation when using two spanning screws. These findings highlight a potential limitation of TNT constructs due to load transfer, stress shielding, and asymmetric osseous integration, particularly in patients with a history of prior unilateral SI joint fusion. https://thejns.org/doi/10.3171/CASE25668.
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