Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up

Abstract

Introduction: Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up. Methods: We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections. Results: Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications. Conclusions: SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time. Level of Evidence: Level IV.

Navigation Assistance in the Surgical Treatment of Severe Neuromuscular Lordoscoliosis in a Child With Cerebral Palsy

“…Винты S2-alar-iliac являются безопасным и эффективным методом фиксации таза у детей с деформацией позвоночника. Результаты через ≥ 10 лет являются удовлетворительными, с низким уровнем отдаленных осложнений и отличной послеоперационной коррекцией и последующим поддержанием фронтального баланса и наклона таза с течением времени [10,11].…”

What’s New in Pediatric Orthopaedics

“…Their safety and long-term efficacy were supported by a series by Mun et al with a minimum 10-year follow-up in which the authors reported a 2% reoperation rate. All reoperations were for the management of late deep infections 20 . It should be noted that many patients develop some lucency around the screw (>2 mm).…”

Finite element analysis of sacral‐alar‐iliac screw fixation for sacroiliac joint dislocation

“…The starting point of an SAI screw is medial to the posterior superior iliac spine below the iliac level, which results in fewer soft tissue problems. Moreover, to date, it has not yet been reported that notable neurovascular or visceral complications from the screws in the setting of spinal deformity or pelvic osteotomy surgery 10,12,13 …”

“…Moreover, to date, it has not yet been reported that notable neurovascular or visceral complications from the screws in the setting of spinal deformity or pelvic osteotomy surgery. 10,12,13 To date, however, few studies have examined SAI screws for SI joint dislocation. To end this, a finite element analysis was performed to compare the stability of SI screw fixation and SAI screws for SI joint dislocation to provide a reference for clinical practice.…”