Evaluation of the Results of Pelvic Fixation in Long Lumbosacral Instrumentations in Elderly Patients

Abstract

Objective: Evaluate the initial results and the possible complications of the combination of pelvic fixation using iliac screws in long instrumentations of the lumbar spine in elderly patients. Methods: An analysis of 38 patients who underwent lumbar spine arthrodesis instrumentation with more than 3 levels, in which we included level L5-S1 and extended the fixation to the iliac crest. Radiological assessment of instrumentation through X-ray of the lumbar spine and pelvis, and computed tomography, to investigate the presence of radiological fusion. Clinical evaluation through a questionnaire of buttock pain including the visual analogue pain score (VAS). Complications related to pelvic instrumentation were investigated. Results: All patients had radiological fusion in the lumbosacral transition. A halo was found around the iliac screw on imaging studies in 31% of patients, but without related symptoms. The questionnaire of buttock pain found that 15% of patients had some low intensity buttock pain (VAS 1-2) and no need to or interest in removing the screws. There was infection at the surgical site in 2% of cases, hematoma in the buttocks in 5%, and vertebral body fracture in the cranial level instrumented in 7% of cases. Conclusions: Pelvic fixation through the iliac screws proved to be effective in protecting the S1 screws in long instrumentations including the L5-S1 level in elderly patients, allowing the radiological bone fusion. The overall results for pain were satisfactory, based on a questionnaire of buttock pain. There are no signs of overload or degeneration of the sacroiliac joints in the early years after surgery. Level of Evidence IV; Case series - therapeutic study.

Epidemiology and Mortality of Thoracolumbosacral Spinal Arthrodesis in Brazil: The Last 10 Years

“…[7][8][9] It is also known that performing surgical procedures involving the spine has increased in recent years, resulting in an increase in postoperative complications, including death. 10 Early diagnosis and treatment are critical to achieving satisfactory outcomes in order to prevent neurological deterioration, the progression of kyphotic deformities, and possible complications. 11 In this context, there are few studies that address thoracolumbosacral spinal arthrodesis and its mortality rate by macroregion in Brazil.…”