Abstract
BackgroundSurgery for adult spinal deformity requires optimal patient-specific spino-pelvic-lower extremity alignment. Distal fixation in thoracolumbar spinal deformity surgery is crucial when arthrodesis to the sacrum is indicated. Although we had performed sacro-pelvic fixation with bilateral S1 and bilateral single iliac screws previously, iliac screw loosening and/or S1 screw loosening occurred frequently. So, the authors attempted to fuse spino-pelvic lesions with the dual iliac screws and S1 pedicle screws.MethodsTwenty-seven consecutive adult spinal deformity patients underwent thoracolumbar-pelvic correction surgery with bilateral double iliac screws between May 2014 and September 2015. Sagittal vertical axis, lumbar lordosis, pelvic tilt, sacral slope, T1 pelvic angle, and global tilt were assessed radiographically and by computed tomography both preoperatively and 24 months postoperatively. Iliac screw loosening, S1 pedicle screw loosening, and screw penetration of the ilium were evaluated 2 years postoperatively.ResultsOnly two patients (7.4%) at 1 year and three patients (11.1%) at 2 years presented with iliac screw loosening postoperatively. Loosening of the S1 screw occurred in three cases (11.1%) 2 years postoperatively. Displacement of the iliac screw occurred in eight cases (25%). Internal and external perforation of the ilium by the iliac screw occurred in six (22.2%) and three (11.1%) cases respectively. One reoperation was performed due to back-out of the iliac screw and rod breakage.ConclusionBilateral dual iliac screws and an S1 pedicle screw system achieve longer stability for spinal and pelvic fusion in adult spinal deformity patients, with few severe complications.
Highlights
Surgery for adult spinal deformity requires optimal patient-specific spino-pelvic-lower extremity alignment
A combination of this procedure was effective in protecting the sacral screws from failure and sacroiliac joint degeneration, sacro-pelvic fixation with bilateral S1 and bilateral single iliac screws for adult spinal deformity (ASD) was associated with breakage or back-out of iliac screws, screw loosening, rod breakage, or pseudarthrosis of L5–S1 within 5 years postoperatively [8]
The inclusion criteria were symptoms including postural imbalance, low back pain, and/or gastro esophageal reflux disease, and a radiographic diagnosis of ASD defined by at least one of the following parameters: a coronal Cobb angle > 30°; a C7 sagittal vertical axis (SVA), which is the distance between the C7 plumb line and the posterosuperior edge of S1, > 5 cm; and/or pelvic tilt (PT), which is the orientation of the pelvis with respect to the femurs and the rest of the body, > 30°
Summary
Surgery for adult spinal deformity requires optimal patient-specific spino-pelvic-lower extremity alignment. A combination of this procedure was effective in protecting the sacral screws from failure and sacroiliac joint degeneration, sacro-pelvic fixation with bilateral S1 and bilateral single iliac screws for ASD was associated with breakage or back-out of iliac screws, screw loosening, rod breakage, or pseudarthrosis of L5–S1 within 5 years postoperatively [8]. To overcome these complications, S2 alar iliac pelvic fixation has been developed and demonstrates better correction of pelvic obliquity with fewer complications [2].
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