Loosening seen in lumbopelvic fixation screws used for adult spinal deformity surgery
Click Here to Manage Email Alerts
Long lumbopelvic fixation failure occurred in 29.4% of adult patients whose fixation to correct adult spinal deformity involved iliac-sacral or S2 alar iliac screws, according to presented results.
Compared with the iliac-sacral (IS) screws, higher rates of loosening were seen with the S2 alar iliac screws (S2AI). However, the S2AI screws were associated with a lower rate of rod fracture, according to study findings Robert K. Eastlack, MD, FAAOS, presented at the North American Spine Society Annual Meeting, which was held virtually.
The study by Eastlack and colleagues was named one of the best papers at the meeting.
As failed fixation in these long constructs may lead to loss of correction, pain and possible pseudarthrosis of the lumbosacral junction, Eastlack and his colleagues studied radiographic fixation status in 287 patients with IS screws and 131 patients with S2AI screws whose data were contained in the International Society for the Advancement of Spine Surgery PON database. The patients, who were operated on at 12 centers, had fusions that involved more than five levels and at least 2 years of follow-up.
Failure, loosening, fracture of a rod below L4 and revision surgery were the primary endpoints of the study.
The 12 spine surgeons who reviewed the radiographs found “loosening occurred in approximately 13% of patients in the iliac fixation group, and fractured screw and S1 screw [loosening] was similar, approximately 2% to 3% each,” Eastlack said. “Lower rod fracture below L4 was nearly 15% for an overall total fixation failure at the lumbopelvic region of 29.4%.”
The rate of revisions performed for any reason was about 22%, he said.
“Notably [health-related quality of life] HRQL improvements were not as good, with pelvic fixation failures occurring,” Eastlack said.
He said, “There is a suggestion that a differential failure mechanism between iliac screws and S2AI fixation exists.”
Collapse
Eastlack RK, et al. Paper 87. Presented at: North American Spine Society Annual Meeting; Oct. 6-9, 2020 (virtual meeting).
Read more about
Click Here to Manage Email Alerts