Comparison of S2-Alar and traditional iliac screw pelvic fixation for pediatric neuromuscular deformity

Lee, Mark C.; Jarvis, Casey A.; Solomito, Matthew J.; Thomson, Jeffrey D.

doi:10.1016/j.spinee.2017.08.253

Cited by 30 publications

(24 citation statements)

References 16 publications

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“…Lee et al [30] recently compared traditional iliac screws to S2AI screws in NMS patients. There were no differences between the groups in regard to postoperative complications or infections.…”

Section: Operative Treatmentmentioning

confidence: 99%

Current concepts in neuromuscular scoliosis

Murphy

Mooney

2019

Curr Rev Musculoskelet Med

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Purpose of Review Spinal deformity is a common issue in pediatric patients with an underlying neurological diagnosis or syndrome. Management of neuromuscular scoliosis (NMS) is a major part of the orthopedic care of such patients, as the deformity is often progressive, and may affect gait, seating and positioning. In addition, untreated large spinal deformities may be associated with pain and/or cardiopulmonary issues over time. Recent Findings Recent changes in medical management of the underlying disease process appears to alter the natural history of certain neuromuscular conditions, and in the case of patients with Duchenne's muscular dystrophy significantly diminish the incidence of spinal deformity. In the most common diagnosis associated with NMS, cerebral palsy, there is evidence that despite a high complication rate, surgical management of spinal deformity is associated with measurable improvements in validated health-related quality-of-life measures. Summary Spinal deformity is a common finding in patients with neurological diagnoses. It is important for those involved in the care of these patients to understand the natural history of NMS, as well as the potential risks and benefits to the patient and caregivers, of surgical and non-surgical interventions.

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Section: Operative Treatmentmentioning

confidence: 99%

Current concepts in neuromuscular scoliosis

Murphy

Mooney

2019

Curr Rev Musculoskelet Med

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“…Mazur et al 58 advocated S2AI screws primarily because of greater cortical purchase and obviation of use of connectors which as used in cases of iliac screws acts as a potential site of failure. Lee et al 63 reported lower incidence of implant failure with S2AI screws as compared to iliac screws. This difference was nullified with the usage of cross links in iliac screw construct.…”

Section: S2ai Screws Vs Iliac Screwsmentioning

confidence: 97%

Sacropelvic fixation techniques - Current update

Nanda

Manghwani

Kluger

2020

Journal of Clinical Orthopaedics and Trauma

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Sacropelvic is a complex junctional area owing to the complex regional anatomy and higher biomechanical stress. However extension of construct is indicated in cases with complex deformities, high grade spondylolisthesis, and complex fractures. The challenges remain which includes pseudoarthrosis and fixation failures. The fixation techniques have constantly evolved over time with better results with iliac screws and S2-alar-iliac screws. This article gives background on evolution, biomechanics, and recent update of use of robotics for sacropelvic fixation.

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“…Lee et al 21 found comparable performance between S2-AI and iliac screws, with improved rates of radiographic implant failure in the S2-AI screw group compared with the iliac screw group, but the rates became equivalent when a cross-link was added to a structural interbody support construct. In the adult population, S2-AI screws were independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.…”

Section: Pooled Resultsmentioning

confidence: 99%

“…Lee et al (2018) 21 Found a higher implant failure rate in pediatric patients with neuromuscular scoliosis who underwent pelvic fixation with standard iliac fixation (57%) compared with S2-AI screws (27%). Interestingly, the authors found the addition of a cross-link in the iliac screw construct, at any level, made implant failure rates comparable between the 2 cohorts.…”

Section: Montero Et Al (2017) 19mentioning

confidence: 99%

Clinical Effectiveness of S2-Alar Iliac Screws in Spinopelvic Fixation in Pediatric Neuromuscular Scoliosis: Systematic Literature Review

Ravindra

Mazur

Brockmeyer

et al. 2020

Global Spine Journal

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Study Design: Systematic literature review. Objectives: To comprehensively review the S2-alar iliac (S2-AI) screw technique for pelvic fixation in pediatric neuromuscular scoliosis. Methods: Articles identified from the PubMed and EMBASE databases were reviewed for relevance and applicability, and the studies were summarized. Results: Eight articles met the inclusion criteria. A total of 277 pediatric patients underwent spinopelvic fixation using S2-AI fixation for neuromuscular scoliosis; the mean follow-up was 3 years (range = 0.75-6 years). Six articles had level III evidence (5 retrospective cohort studies, 1 observational study), and 2 articles had level IV evidence (case series). Wound complications occurred in 34 (12.2%) patients. Instrumentation complications occurred in 36 patients (13.0%), including lucency around the screw (6.5%), screw fracture (3.6%), disengaging of the set/screw or rod from the tulip head (2.8%), and screw displacement (0.7%). Three patients (1.1%) required reoperation for instrumentation failures. The overall reoperation rate—including 3 hardware replacements and 3 cases of L5-S1 pseudarthrosis—was 2.1%. The mean Cobb angle correction was 51.4°, and the mean pelvic obliquity correction was 14.8°; deformity correction was maintained at 3- and 5-year follow-ups. There were 10 (3.6%) cases of implant prominence/implant-related pain, 1 case of sacroiliac joint pain (resolved with longer screw placement), and no major neurological or vascular complications secondary to S2-AI screw placement. Conclusions: This review suggests that the use of S2-AI screws in pediatric neuromuscular scoliosis is efficacious with a reasonable safety profile and provides a useful technique for pelvic fixation in children with scoliosis.

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Comparison of S2-Alar and traditional iliac screw pelvic fixation for pediatric neuromuscular deformity

Cited by 30 publications

References 16 publications

Current concepts in neuromuscular scoliosis

Current concepts in neuromuscular scoliosis

Sacropelvic fixation techniques - Current update

Clinical Effectiveness of S2-Alar Iliac Screws in Spinopelvic Fixation in Pediatric Neuromuscular Scoliosis: Systematic Literature Review

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