A Comparison of Early Clinical and Radiographic Complications of Iliac Screw Fixation Versus S2 Alar Iliac (S2AI) Fixation in the Adult and Pediatric Populations

Ilyas, Haariss; Place, Howard M.; Puryear, Aki

doi:10.1097/bsd.0000000000000222

Cited by 95 publications

(64 citation statements)

References 11 publications

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“…Shabtai et al [14] also reported that in patients with neuromuscular scoliosis, implant failure rate was lower and surgical revision was less frequent with SAI screws than with iliac screws. In other reports, the reoperation rate after iliac screw fixation was as high as 35%-48%, and lumbopelvic fixation using SAI screws reduced the need for reoperation by as much as 8.6%-14.5% [13,15,16]. Thus, SAI screws appear to have advantages over iliac screws in terms of reducing implant failure and lowering the rate of reoperation.…”

Section: Discussionmentioning

confidence: 79%

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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Section: Discussionmentioning

confidence: 79%

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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“…Different techniques for pelvic fixation exist and are associated with different complication rates. [12][13][14] Because this study was performed using CPT codes, only the general procedure was accounted for, so it was not possible to determine the effect of specific techniques used. Furthermore, patients were matched by total relative value units to account for case mix, fusion approach, and additional operative features such as pedicle subtraction osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies on pelvic fixation have considered the differences in complications between different techniques for extension to the pelvis. [12][13][14] Others have been noncomparative investigations, focusing solely on outcomes. [15][16][17] To our knowledge, no study has used a large, multiinstitutional database to describe the risk profile for pelvic fixation in patients who undergo fusion for ASD.…”

Section: Introductionmentioning

confidence: 99%

Thirty-Day Morbidity Associated with Pelvic Fixation in Adult Patients Undergoing Fusion for Spinal Deformity

Kothari

Somani

Lee

et al. 2017

Global Spine Journal

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Study DesignRetrospective study of prospectively collected data.ObjectiveTo determine if patients undergoing spinal deformity surgery with pelvic fixation are at an increased risk of morbidity.MethodsThe American College of Surgeons National Surgical Quality Improvement Program is a large multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from ~400 hospitals nationwide. Current Procedural Terminology codes were used to query the database between 2010 and 2014 for adults who underwent fusion for spinal deformity. Patients were separated into groups of those with and without pelvic fixation. Univariate analysis and multivariate logistic regression were used to analyze the effect of pelvic fixation on the incidence of postoperative morbidity and other surgical outcomes.ResultsMultivariate analysis showed that pelvic fixation was a significant predictor of overall morbidity (odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.7 to 3.1, p = 0.0002), intra- or postoperative blood transfusion (OR = 2.3, 95% CI: 1.7 to 3.1 p < 0.0001), extended operative time (OR = 4.7, 95% CI: 3.1 to 7.0 p < 0.0001), and length of stay > 5 days (OR = 2.1, 95% CI 1.5 to 2.8, p < 0.0001) in patients undergoing fusion for spinal deformity. However, fusion to the pelvis did not lead to additional risk for other complications, including wound complications (p = 0.3191).ConclusionAdult patients undergoing spinal deformity surgery with pelvic fixation were not susceptible to increased morbidity beyond increased blood loss, greater operative time, and extended length of stay.

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“…Traditional sacropelvic fixation includes trans‐iliac bars and iliac and iliosacral screws. However, these require separate incisions for the use of offset connectors, thus increasing the surgical time and incidence of complications …”

Section: Discussionmentioning

confidence: 99%

“…O'Brien et al subsequently adapted it for use in minimally invasive applications . Ilyas et al found that S2AI technique is associated with significantly fewer clinical and radiographic complications in adult patients than the iliac screw technique . The S2AI technique for pelvic fixation is a modification of an S 2 alar screw driven through the sacroiliac articulation into the iliac wing.…”

Section: Discussionmentioning

confidence: 99%

S₂ Alar‐iliac Fixation: A Powerful Procedure for the Treatment of Kyphoscoliosis

Liu

Qiu

Huang

et al. 2016

Orthopaedic Surgery

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The purpose of this study was to introduce a powerful technique for the treatment of kyphoscoliosis. There are currently multiple techniques for sacropelvic fixation, including trans-iliac bars and iliac and iliosacral screws. Several studies have documented the use of these instrumentation techniques; however, a ubiquitous problematic issue concerns the need for separate incisions for the use of offset connectors, which add to surgical time and morbidity. Any additional dissection of the skin, subcutaneous tissue or muscle in this area is believed to increase the incidence of complications of wound healing. However, as stated above, the above-mentioned techniques require separate incisions for the use of offset connectors, which add to surgical time and morbidity. The novel technique of S2 alar-iliac (S2AI) pelvic fixation has been developed to address some of these issues. However, a technique for achieving correction of kyphoscoliosis with pelvic obliquity in adult patients with spinal deformity has not previously been described. Our entry point is based on the S1 foramen and is typically up to 5 mm caudal and 2 to 3 mm lateral to that foramen. Once the S1 foramen has been identified, a blunt instrument can be used to probe the alar ridge. The screw trajectory is 40°-50° from horizontal and 20°-30° caudal, aimed toward the greater trochanter and rostral to the sciatic notch. A 36-year-old female patient presented with a 3-year history of low back pain, and progressive thoracolumbar kyphoscoliosis. In this typical case, we performed S2AI fixation with transforaminal lumbar interbody fusion and hemivertebra resection technique to treat her lumbosacral kyphoscoliosis. Satisfactory improvement in her preoperative lumbar kyphoscoliosis was found at 3-month follow-up.

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A Comparison of Early Clinical and Radiographic Complications of Iliac Screw Fixation Versus S2 Alar Iliac (S2AI) Fixation in the Adult and Pediatric Populations

Abstract: Level III.

Cited by 95 publications

References 11 publications

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

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

Thirty-Day Morbidity Associated with Pelvic Fixation in Adult Patients Undergoing Fusion for Spinal Deformity

S₂ Alar‐iliac Fixation: A Powerful Procedure for the Treatment of Kyphoscoliosis

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A Comparison of Early Clinical and Radiographic Complications of Iliac Screw Fixation Versus S2 Alar Iliac (S2AI) Fixation in the Adult and Pediatric Populations

Abstract: Level III.

Cited by 95 publications

References 11 publications

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

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

Thirty-Day Morbidity Associated with Pelvic Fixation in Adult Patients Undergoing Fusion for Spinal Deformity

S2 Alar‐iliac Fixation: A Powerful Procedure for the Treatment of Kyphoscoliosis

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S₂ Alar‐iliac Fixation: A Powerful Procedure for the Treatment of Kyphoscoliosis