Ilio-lumbar Fixation—The Amrita Technique

Abstract

Surgical technique description. To describe a surgical technique of ilio-lumbar fixation with iliac screws, which attempts to overcome some of the current limitations and technical difficulties associated with this surgery. The iliac screw technique, which is the most commonly used method of ilio-lumbar fixation, has certain limitations that need special consideration. These include soft tissue coverage, improving the strength of distal anchorage, reducing hardware prominence, avoiding complex 3-dimensional rod contouring, preventing neurologic injury, and acetabular violation. Over the past 5 years, we have used our technique in 8 patients (4 sacral tumors, 2 fracture dislocations, and 2 spinal tuberculosis). In 6 cases, the sacrum was not available for anchoring and hence was bypassed. The follow-up ranged from 3 to 54 months, and 5 patients had resumed normal activities. In 7 cases, the wound healed primarily and the solitary wound failure was in a previously irradiated skin. Other complications like neurologic deficit secondary to the procedure, acetabular violation, and implant failure were not encountered. Our technique of ilio-lumbar fixation provides a stable and simple alternative to reconstruct potentially devastating instability of the lumbosacral junction. The 2 iliac screws, when used as described, make the procedure technically easier, reduce the hardware prominence without compromising the stability to construct and provide adequate bone graft.