Resultado a largo plazo de las fusiones largas espinopelvicas en escoliosis: importancia de la edad, la capacidad de marcha y el tipo de fijación ilíaca

Abstract

Objective: To determine the factors that influence lumbosacral instrumentation failures following spinopelvic fusions. Methods: A retrospective study of patients diagnosed with scoliosis who underwent spinopelvic fusion via posterior, from T2 or T3 proximally to iliac crest, using pedicle and iliac screws. Instrumentation failures were analyzed, and the association of this complication with different parameters was studied. Results: We present 44 patients, with an average age of 24 years, with different etiologies. The mean value of the largest preoperative major curve was 74.2°, and in the final review, it was 67%. The anterior-posterior imbalance, pelvic tilt, thoracic kyphosis, lumbar lordosis and lateral imbalance were significantly improved in the final review. There were instrumentation failures in 41% cases, all at the lumbosacral level. A significant association was found between increased instrumentation failures in patients over 17 years and in patients with independent walking ability. In 24 patients, a bilateral single iliac screw was used and in 20 patients, two or more screws were used. Both groups had a similar incidence of failures. In the group with two or more screws, only rod breakages occurred, without detachment or screw lysis. There was lower instrumentation failure incidence in the patients who underwent L3-S1 interbody fusion or a third rod attached with sublaminar compression hooks. Conclusions: This series had 41% instrumentation failures, all located at lumbosacral level. There were significant more instrumentation failures in patients with independent walking ability and those aged over 17 years. There was lower instrumentation failure incidence in the patients who underwent L3-S1 interbody fusion or a third rod attached with sublaminar compression hooks.

Sacropelvic Fixation Using Iliac Screws: Evaluation of Technique and Complications

“…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. Cabada 35 reported 31.8% of rod breakage at the lumbosacral level in his follow-up study of sacropelvic fixation in scoliosis. He reported an interesting relationship regarding age and walking ability, showing with statistical significance that those patients younger than 17 years of age or unable to walk had a lower implant failure rate, but he did not observe significance between the two associated characteristics.…”