Outcome and Complications of Long Fusions to the Sacrum in Adult Spine Deformity

Emami, Arash; Deviren, Vedat; Berven, Sigurd; Smith, Jason A.; Hu, Serena S.; Bradford, David S.

doi:10.1097/00007632-200204010-00017

Cited by 370 publications

(107 citation statements)

References 20 publications

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“…The average number of levels fused was 6.08 segments (range [4][5][6][7][8] in the L5 group and 6.09 (range 4-9) in the sacrum group with no statistical difference. The upper instrumented vertebra (UIV) was T9 in 2 patients, T10 in 11 patients, T11 in 3 patients, T12 in 3 patients, and L1 in 5 patients in the L5 group.…”

Section: Operative Proceduresmentioning

confidence: 83%

“…Higher rates of pseudarthrosis may be associated with a less rigid fixation method. Emami et al [6] found a significant pseudarthrosis rate in 36% of patients with the Luque Galveston technique and 14% of patients with the sacral and iliac screws. Bridwell et al [2] noted that they did not have a failure of the sacral screws by combination with anterior structural support and iliac screw fixation.…”

Section: Discussionmentioning

confidence: 98%

“…Long fusion constructs are often associated with instrumentation failure [6,10]. Instrumentation failures result from inadequate fixation, poor bone quality, and multiple levels requiring arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

“…Emami et al [6] investigated 54 patients who underwent long fusion to the sacrum for adult spinal deformity. They favored bicortical sacral screws with structural anterior column support at the lumbosacral junction in patients with good bone stock, and when the coronal and sagittal balance is achievable.…”

Section: Discussionmentioning

confidence: 99%

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Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis

et al. 2009

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There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4-8) in the L5 group and 6.09 (range 4-9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7°before surgery to 6.8°after surgery in the L5 group, and from 22.8°to 7.7°in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.

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Section: Operative Proceduresmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis

et al. 2009

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“…Poor bone stock or osteopenia, older fixation systems and inadequate fixation, failure to achieve spinal coronal and sagittal balance, and patient-specific factors have all been implicated in contributing to poor outcomes. [1][2][3][4][5][6] Emami et al 7 have addressed 3 concepts that derived from previous work and their own observations: (1) the benefit of interbody structural support at the lumbosacral junction, (2) the emphasis of L5 and S1 pedicle fixation, and (3) the importance of achieving spinal balance. In their 2002 retrospective study of 54 patients, they reported an 8.5% pseudarthrosis rate in 12 patients treated with posterior Isola segmental instrumentation using triangulated bicortical sacral screws and no iliac fixation.…”

mentioning

confidence: 99%

Comprehensive Analysis of Cantilever, Translational, and Modular Corrective Techniques in Adults with Scoliosis Treated with Surgery to the Sacropelvis

Mermer

Boachie-Adjei

Rawlins

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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Eighty-nine patients underwent combined anterior and posterior surgery, whereas 8 patients were treated with posterior-only procedures. Two patients had fixation to the sacrum without extension into the ilium. Structural curves averaged 53 degrees preoperatively, 32 degrees postoperatively, and 33 degrees at follow-up. Thoracic kyphosis averaged +36 degrees preoperatively, +39 degrees postoperatively, and +46 degrees at follow-up. Lumbar lordosis averaged -41 degrees preoperatively, -48 degrees postoperatively, and -48 degrees at follow-up. Coronal imbalance averaged 2.9 cm preoperatively, 2.4 cm postoperatively, and 2.3 cm at follow-up. Sagittal imbalance averaged 6.8 cm preoperatively, 2.9 cm postoperatively, and 3.6 cm at follow-up. Major complications included pseudarthrosis (10%), deep infection (13%), painful iliac fixation (20%), neurologic injury (6%), need for some form of revision surgery (39%), chronic severe pain (2%), pulmonary embolism (2%), and deep venous thrombosis (2%). There were no permanent neurologic injuries or deaths related to the surgery.

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Metric study of Egyptian sacrum for lumbo‐sacral fixation procedures

Hassanein

2011

Clinical Anatomy

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Lumbo-sacral fixation for the management of lumbo-sacral instability includes insertion of screws to the sacrum, most commonly into the posterior aspect of the pedicles of the first sacralvertebra. This study was carried out to determine the normal anatomical parameters of the Egyptian sacrum, particularly of the first sacral vertebra and its pedicles, to find the safest approach for sacral screw placement in lumbo-sacral fixation procedures, and to describe racial characteristics, if any. In this study, 45 adult Egyptian dry sacra of unknown sex were used. Eleven sacral parameters were measured using the Vernier sliding caliper which is accurate to 0.1 millimeter. In this study, the sacrum showed a mean height of 11.43 ± 0.88 centimeters a mean width of 10.39 ± 0.91 centimeters with a mean sacral index of 90.82 ± 1.80 %. The first sacral pedicle had a mean anterior height of 1.83 ± 0.49 centimeters, a mean depth of 2.99 ± 0.53 centimeters and a mean posterior height of 2.38 ± 0.50 centimeters. A medialtrajectory path (representing an anteromedially-oriented first sacral pedicle screw) starting from the infero-lateral border of the S1 facet to the sacral promontory in the middle line was 5.23 ± 0.52 cm. The findings of the present study could provide accurate and specific parameters of the sacrum among Egyptians that could enhance the safety of insertion of sacral screws during lumbo-sacral fixation procedures upon Egyptian patients.

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Outcome and Complications of Long Fusions to the Sacrum in Adult Spine Deformity

Cited by 370 publications

References 20 publications

Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis

Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis

Comprehensive Analysis of Cantilever, Translational, and Modular Corrective Techniques in Adults with Scoliosis Treated with Surgery to the Sacropelvis

Metric study of Egyptian sacrum for lumbo‐sacral fixation procedures

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