Use of S2-Alar-iliac Screws Associated With Less Complications Than Iliac Screws in Adult Lumbosacropelvic Fixation

Elder, Benjamin D.; Ishida, Wataru; Lo, Sheng Fu L.; Holmes, Christina; Goodwin, C. Rory; Kosztowski, Thomas; Bydon, Ali; Gokaslan, Ziya L.; Wolinsky, Jean Paul; Sciubba, Daniel M.; Witham, Timothy F.

doi:10.1097/brs.0000000000001722

Cited by 116 publications

(115 citation statements)

References 26 publications

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“…Many reports on SAI screws have discussed favorable outcomes related to deformity correction, low rates of infection, and implant-related complications [6,[12][13][14]. Sponseller et al [6] investigated 32 children who underwent spinal deformity surgery and found that correction of pelvic obliquity (20°±11°, 70%) was significantly better with SAI screw placement than with other iliac anchors.…”

Section: Discussionmentioning

confidence: 99%

“…Sponseller et al [6] investigated 32 children who underwent spinal deformity surgery and found that correction of pelvic obliquity (20°±11°, 70%) was significantly better with SAI screw placement than with other iliac anchors. Elder et al [12] conducted a retrospective study comparing 25 cases involving iliac screws and 65 cases involving SAI screws, and found that reoperation, surgical-site infection, wound dehiscence, and symptomatic screw prominence were less frequent with SAI screws. 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.…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Compared to the iliac screw, the advantage of the S2-AI method includes a lower profiling setting of the screw, less extensive dissection of tissue, and higher pullout resistance [25,26]. Elder et al reported use of the S2-AI as an independent predictor of preventing reoperation and surgical site infection [27]. However, the long-term influence of SI joint fixation remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

Yahara

Yasuda

Kawaguchi

et al. 2020

BMC Musculoskelet Disord

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Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population. Methods: A total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined. Results: The most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH-group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis. Conclusions: Anterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.

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“…18 Nonetheless, concerns include the need for more extensive soft-tissue dissection, need for complex connector systems, instrumentation pain/prominence, and others. 10 On the other hand, S2AI screws were first described for use in pediatric patients with scoliosis 19 but have gained popularity in adult patients given recently reported favorable outcomes, 5,9 including lower complication rates and no need for connectors (given that they are placed in line with lumbar and S1 pedicle screws), among others. 10 The purpose of the present study was to conduct a me-ta-analysis comparing IS fixation and S2AI screw fixation techniques in adults, with an emphasis on rates of revision surgery and wound complications.…”

mentioning

confidence: 99%

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Ramos

Nakhla

Sciubba

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)—27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)—25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)—18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

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Use of S2-Alar-iliac Screws Associated With Less Complications Than Iliac Screws in Adult Lumbosacropelvic Fixation

Abstract: 4.

Cited by 116 publications

References 26 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

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

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