An early experience of lumbopelvic fixation techniques at Alexandria University

Springer Science and Business Media LLC - Tập 36 Số 1 - 2021
Islam Sorour1, Mohamed Abd El-Bary1, Ahmed Rabie1, Abdelrahman Magdy Elhabashy1
1Neurosurgery Department, Alexandria University, Alexandria, Egypt

Tóm tắt

Abstract Background The aim of lumbopelvic fixation is to obtain a solid fusion across the lumbosacral junction. There are many indications for lumbopelvic fixation, namely, spinal deformity in cases requiring long segment fusion, pelvic obliquity, pseudarthrosis at the lumbosacral junction, infection or osteolytic tumors, and pathologic fractures. The classical iliac screws should be contained within the iliac bone but have some disadvantages: excessive soft tissue dissection needed for accurate insertion, screw prominence with patient discomfort, and usually, a side connector is needed to connect the iliac screws to the rest of the construct. Lumbopelvic fixation by insertion of S2 alar-iliac (S2AI) screws was recently described to overcome these disadvantages. In this study, the authors present the initial results for the evaluation of lumbopelvic fixation through the insertion of S2AI screws in 19 consecutive patients operated in the neurosurgery department at Alexandria University. Objective The aim of the study was to evaluate the efficacy and complications of lumbopelvic fixation through the use of S2 alar-iliac screws. Methods The authors conducted a retrospective cohort study of data collected from the database of patients who underwent lumbopelvic fixation through the insertion of S2AI screws from 2016 to 2019 at a single institution. Results There were 19 patients indicated for lumbopelvic fixation, operated by modern instrumentation systems using lumbar pedicle screws and S2 alar-iliac screws. There were 14 females and 5 males. The mean age at the time of the operation was 38.6 ± 19.4 years with a range from 11 to 65 years. There was a total of 37 S2AI screws, screw diameter was 7mm in all cases regardless of age, and the length of the screws ranged from 50 mm in a young female patient (11 years) to 90 mm in an old male patient (60 years). Two screws were inserted per patient except in one case with congenital scoliosis due to the bad bone quality and the multiple iatrogenic wrong paths. Postoperative VAS score for back pain was greatly improved in all patients after the first 6 months of follow-up from 8 ± 1.5 to 3.5 ± 1.2 (paired t-test = 11.182, P<0.001). All patients had a good spinal range of motion to maintain normal daily activities without any significant restrictions after the first 3 months of follow-up. Immediate postoperative radiological follow-up had revealed 2 cases of posterior pelvic breaches and one case with anterior pelvic breach but without clinical manifestations with no need for revision. Two cases of unilateral screw breakout were observed after the first 6 months of follow-up. Removal of screws after the first 6 months was done in one patient with spondylodiscitis due to the unresolved infection and screw pullout. Conclusion The insertion of S2AI screws is an effective technique for lumbopelvic fixation with a relatively low rate of complications. Pelvic breaches are the commonest complications encountered during the insertion of S2AI screws, although no significant clinical morbidities were reported.

Từ khóa


Tài liệu tham khảo

Jones CB, Sietsema DL, Hoffmann MF. Can lumbopelvic fixation salvage unstable complex sacral fractures? Clin Orthop Relat Res. 2012;470(8):2132–41.

Suk SI, Chung ER, Lee SM, Lee JH, Kim SS, Kim JH. Posterior vertebral column resection in fixed lumbosacral deformity. Spine (Phila Pa 1976). 2005;30(23):E703–10.

Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, et al. Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976). 2001;26(18):1976–83.

Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM. Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone Joint Surg Am. 2015;97(18):1521–8.

Ilyas H, Place H, Puryear A. A comparison of early clinical and radiographic complications of iliac screw fixation versus S2 alar iliac (S2AI) fixation in the adult and pediatric populations. J Spinal Disord Tech. 2015;28(4):E199–205.

Shillingford JN, Laratta JL, Tan LA, Sarpong NO, Lin JD, Fischer CR, et al. The free-hand technique for S2-alar-iliac screw placement: a safe and effective method for sacropelvic fixation in adult spinal deformity. J Bone Joint Surg Am. 2018;100(4):334–42.

Yilmaz E, Abdul-Jabbar A, Tawfik T, Iwanaga J, Schmidt CK, Chapman J, et al. S2 alar-iliac screw insertion: technical note with pictorial guide. World Neurosurg. 2018;113:e296–301.

Chang TL, Sponseller PD, Kebaish KM, Fishman EK. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976). 2009;34(5):436–40.

Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976). 2004;29(3):333–42 discussion 42.

Ct K, Maher PC, Levine NB, Kurokawa R. Prospective evaluation of thoracic pedicle screw placement using fluoroscopic imaging. J Spinal Disord Tech. 2004;17(3):206–14.

Yoshihara H. Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options. Eur J Orthop Surg Traumatol. 2014;24(Suppl 1):S73–82.

Kebaish KM. Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976). 2010;35(25):2245–51.

Guler UO, Cetin E, Yaman O, Pellise F, Casademut AV, Sabat MD, et al. Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J. 2015;24(5):1085–91.

Sponseller PD, Zimmerman RM, Ko PS, Pull Ter Gunne AF, Mohamed AS, Chang TL, et al. Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine (Phila Pa 1976). 2010;35(20):1887–92.

Park JH, Hyun SJ, Kim KJ, Jahng TA. Free hand insertion technique of S2 sacral alar-iliac screws for spino-pelvic fixation: technical note, acadaveric study. J Korean Neurosurg Soc. 2015;58(6):578–81.

Kim YJ, Bridwell KH, Lenke LG, Cho KJ, Edwards CC, 2nd, Rinella AS. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg Am. 2006;88(4):721-8.

O’Brien JR, Yu WD, Bhatnagar R, Sponseller P, Kebaish KM. An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976). 2009;34(12):E439–42.

Mattei TA, Fassett DR. Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: technical note. J Neurosurg Spine. 2013;19(3):321–30.

Mazur MD, Ravindra VM, Schmidt MH, Brodke DS, Lawrence BD, Riva-Cambrin J, et al. Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine. 2015;23(1):67–76.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 36 Số 1

Thông tin tác giả