Minimally invasive lumbopelvic instrumentation for traumatic sacrolisthesis in an elderly patient

Abstract

Purpose We present a novel minimally invasive technique for lumbopelvic instrumentation in selected elderly patients suffering from traumatic sacrolisthesis. An 82-year-old female suffered from sacrolisthesis after a fall. She developed significant low back pain and bilateral lower extremity radiculopathy. Preoperative radiographs and magnetic resonance imaging sequences demonstrated the fracture dislocation between S1 and S2 with compromise of the spinal canal. Lumbopelvic instrumentation was sought to offer fixation and allow mobilization; however, open lumbopelvic instrumentation techniques have significant morbidity, especially in this patient population of elderly patients with medical comorbidities. Methods A minimally invasive technique employing percutaneous pedicle screws at L5 and S1 coupled with percutaneous S2 iliac screws was employed. Results and conclusions The patient tolerated the procedure well without any complications or morbidity. At the last follow-up of 14 months, she was ambulating without assistance with near total resolution of back pain and radicular pain. Radiographs obtained at 8 months' followup demonstrated fusion across the fracture line. Although further follow-up data is still needed to establish the durability of this technique in the long-term, this minimally invasive technique for lumbopelvic instrumentation can be considered as an option in elderly patients with traumatic sacrolisthesis, whose need for early mobilization and medical comorbidities preclude the use of an open lumbopelvic fixation procedure.

A Case Series that Supports the Application of the S2AI Technique for Fractures and Failures after Lumbosacral Fusion

“…S2AI screws are biomechanically as stable as test constructs using iliac screws; O'Brien et al found that S2AI screws of 65 to 80 mm in length were biomechanically equivalent to 90-mm iliac screws [17]. Using the S2AI technique, 40 to 50 mm of the screw has sacral purchase, and the remainder of screw is within the ilium [15, 28]. Because S2AI screws are 15 mm deeper than iliac screws, S2AI screw fixation results in less-prominent hardware than does iliac screw fixation [23].…”

Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw : Technical Case Series

“…S2 alar-iliac (S2AI) screws, an alternative for the traditional iliac wing screws, have recently been introduced and have become popular. Several studies have reported successful results with the S2AI screws in adult and pediatric populations 13 , 17 , 19) . The major advantages of S2AI screws over traditional iliac wing screws are that they have a lower profile, they are in line with the cephalad instrumentation without the need for offset connectors, and they do not require a separate fascial incision 2 , 14 , 17) .…”