Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure

Güler, Ümit Özgür; Çetin, Engin; Yaman, Onur; Pellisé, Ferran; Casademut, Alba Villa; Sabat, Montse Domingo; Alanay, Ahmet; Grueso, Francesco Sanchez Perez; Acaroğlu, Emre

doi:10.1007/s00586-014-3615-1

Cited by 117 publications

(83 citation statements)

References 15 publications

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“…The 5 selected studies were all retrospective cohort studies comparing outcomes of IS fixation and S2AI screw fixation techniques in adults. 5,[7][8][9]13 Based on the NASS guidelines, all studies were graded as level III evidence (retrospective comparative studies). After risk-of-bias analysis, it was found that all studies had a high risk of selection and performance bias given their nonrandomized and nonblinded nature (Fig.…”

Section: Literature Review and Study Qualitymentioning

confidence: 99%

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Ramos

Nakhla

Sciubba

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)—27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)—25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)—18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

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Section: Literature Review and Study Qualitymentioning

confidence: 99%

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Ramos

Nakhla

Sciubba

et al. 2019

Journal of Neurosurgery: Spine

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“…Rigid distal fixation of the spine is essential for maintaining proper sagittal and coronal balance. Lumbosacral fusion provides a biomechanical support at the base of a long construct; however, high instrument failure and reoperation rates have been reported when S1 screws are used alone [1,2]. The L5-S junction has the highest risk of pseudoarthrosis, with a reported rate of 24% and is associated with adverse clinical outcomes [3].…”

Section: Introductionmentioning

confidence: 99%

“…The L5-S junction has the highest risk of pseudoarthrosis, with a reported rate of 24% and is associated with adverse clinical outcomes [3]. Multiple studies have shown that long instrumentation and fusion at the sacrum require supplemental pelvic fixation in order to prevent these complications [1,2]. To date, several techniques have been reported, including the use of iliac screws, S2 pedicle screws [4], sacral alar screws [5], and S2 alar-iliac (SAI) screws [1,6].…”

Section: Introductionmentioning

confidence: 99%

The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up

et al. 2020

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Study Design: A retrospective cohort study.Purpose: The purpose of this study was to investigate the prevalence and risk factors for S2 alar-iliac (SAI) screw loosening following lumbosacral fixation, with a minimum 2-year follow-up.Overview of Literature: Although SAI screws allow surgeons to perform lumbosacral fixation with a low profile and enhanced biomechanical strength, screw loosening following surgery can occur in some cases. However, few studies have investigated the prevalence and risk factors for SAI screw loosening.Methods: This retrospective study included 35 patients (mean age, 72.8±8.0 years; male, 10; female, 25) who underwent lumbosacral fixation using SAI screws with at least 2 years of follow-up. SAI screw loosening and L5–S bony fusion were assessed using computed tomography. The period for which the screws appeared loose and the risk factors for SAI screw loosening were investigated 2 years after surgery.Results: A total of 70 SAI screws and 70 S1 pedicle screws were inserted. Loosening was observed 0.5, 1, and 2 years after surgery in 17 (24.3%), 35 (50.0%), and 35 (50.0%) SAI screws, respectively. Bony fusion rate at L5–S was significantly lower in patients with SAI screw loosening than in those without screw loosening (65.0% vs. 93.3%, p =0.048). The score for SAI screw contact with the iliac cortical bone and the bony fusion rate at L5–S were significantly lower in the loosening group than in the non-loosening group (1.8±0.5 vs. 2.2±0.3, p <0.001, respectively). Postoperative pelvic incidence–lumbar lordosis was significantly higher in the loosening group than in the non-loosening group (7.9°±15.4° vs. 0.5°±8.7°, p =0.02, respectively).Conclusions: SAI screw loosening is closely correlated with pseudoarthrosis at L5–S. Appropriate screw insertion and optimal lumbar lordosis restoration are important to prevent postoperative complications related to SAI screws.

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“…5,6,25,48,49,[53][54][55][56][57]60 However, these procedures are often complex and may be associated with high rates of complications. 4,6,14,15,17,22,39,44,45,[50][51][52]55,58,61,63 Previously reported studies of ASD surgery complications have been limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Improved understanding of the types of complications and their rates of occurrence with ASD surgery, both during the perioperative period and over the course of follow-up, is important for treatment planning, patient counseling, and ongoing efforts to improve the safety of care.…”

mentioning

confidence: 99%

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

SPI

300

178

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OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure

Cited by 117 publications

References 15 publications

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

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