Abstract
BackgroundTo date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.MethodsA retrospective review of consecutive patients who underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change < 5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.ResultsA total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26°, 39.8 ± 13.8°) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9°, 30.3 ± 9.9°) (p < 0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p < 0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p < 0.05) and (16.1% vs 3.6%, p < 0.05).ConclusionsCompared with the S2AI technique, the IS technique usable larger cantilever force demonstrated more correction of lumbar lordosis, and possible increase in pelvic incidence. Further study is warranted to clarify the clinical impaction of these results.
Highlights
To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation
After institutional review board approval, we performed a retrospective review of consecutive patients who underwent long-segment (≥6 levels) spinal fusion and pelvic fixation using IS or S2AI technique at a single institution between 2013 and 2017
Patient characteristics and perioperative data In total, 142 patients with a mean follow-up duration of 32.3 months were included in the study and analysis: 111 received IS technique and 31 received S2AI technique
Summary
There is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation. Spinopelvic fixation (SPF) is becoming an increasingly important avenue for degenerative conditions as the aging population grows. This instrumentation technique can be applied in high-grade spondylolisthesis, trauma, tumors or infection. Achieving solid fixation in lumbosacral junction continues to be a challenge for spine surgeons because of the tremendous biomechanical forces demand across the junctional area, complex regional anatomy, and a high pseudarthrosis rate, especially in patients with adult spinal deformity (ASD) [1,2,3,4,5]. Tsuchiya et al [9] reported that up to 34% ASD patients treated via IS technique necessitating reoperations due to prominence
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