Fijación espinopélvica en el adulto: criterios de selección

Abstract

OBJETIVO: mencionar nuestros criterios de selección para realizar fijación espinopélvica en patología degenerativa del adulto. MÉTODO: entre 2005 y 2008, analizamos 25 pacientes intervenidos quirúrgicamente con técnica de fijación espinopélvica con tornillos ilíacos. Criterios de selección: 1) Deformidades graves asociadas a desequilibrio espinopélvico. 2) Fusiones multiniveles asociadas a patología degenerativa del primer espacio móvil. 3) Cirugías de revisión: cifoescoliosis o espondilolistesis de alto grado. Se evaluaron edad, sexo, Score de Owestry preoperatorio y posoperatorio y complicaciones. RESULTADO: La edad fue de 55 a 75 años (promedio 67,8). Dos pacientes eran del (8%) de sexo masculino y 23 (92%), del femenino. Promedio de seguimiento: 2,5 años. Score de Owestry, promedio preoperatorio: 67,44% y posoperatorio: 9,76 %. Hubo tres complicaciones: infección aguda, pseudoartrosis y aflojamiento de tornillos ilíacos. CONCLUSIÓN: La fijación espinopélvica con tornillos ilíacos es una técnica sencilla que nos asegura un óptimo anclaje distal para la artrodesis lumbosacra en cirugías de revisión y deformidades complejas.

Sacropelvic Fixation Using Iliac Screws: Evaluation of Technique and Complications

“…33 An 8% infection rate was found by Phillips 21 in treating patients with neuromuscular scoliosis. Rudt 5 observed 4% infection in his sample in sacropelvic fixation in adults. It is appropriate to discuss whether the pathology influenced the difference observed in rates of infection, even though the samples in the two studies were small.…”

“…It is comprised of five vertebrae and its dimensions range from 47 mm in S1 to 28 mm in S2 in the anterior posterior direction in women and from 50 mm in S1 and 31 mm in S2 in men. 5 Formed mostly of spongy bone, its highest density is found in the regions of the promontory and wings. The measurements of the pedicle of S1, trapezoidal in shape and about 20 mm in the horizontal plane and 25 to 30 mm in the vertical plane, are also significant.…”

“…4 The sacrum has a relationship with several important vascular and neurological structures, which must be considered when inserting screws. 5 In his study on sacral fixation, Arlet 4 cites the ilium as the only pelvic fixation point that allows screw insertion anteriorly to the center of the osteoligamentous spine. Furthermore, he compares the ilium to a long bone with a diaphyseal portion anteriorly delimited by the head of the acetabulum and the anterior inferior iliac spine and posteriorly by the portion between the two posterior iliac spines.…”

“…There are several comparative studies of sacropelvic fixation techniques, most of which compare the Galveston technique with that using bilateral iliac screws, even though the principal is the same. Rudt, 5 for example, concluded that iliac screws are easier to place, they offer the possibility of using more than one screw in each ilium, and anchoring in the bone is more efficient and offers greater resistance to pull-out. Along the same lines, Ernami 12 observed high rates of pseudoarthrosis using the Galveston fixation in the correction of adult spinal deformities and Peelle 13 reported complications resulting from the difficult modeling of rods to fit the iliac curves.…”

“…Discomfort, pain, and wounds caused by the prominence of screws in the sacral region were routine complications encountered in the various studies about the use of the technique. 5,16,18,33,34 Kasten 34 reported the removal of iliac screws in 6 out of 78 patients, around 7.7%, because of complaints of local pain. Halos around the iliac screws are common, but they do not necessarily have any influence on the assessment of lumbosacral fusion, 32 unlike breakage of the material (rod, screw, or connector), a sign of prodromal pseudoarthrosis.…”