LONG‐SEGMENT SPINAL FIXATION USING PELVIC SCREWS

OBJECTIVELong spinal constructs that extend to the sacrum place added stress on sacral screws. To prevent premature loosening of sacral fixation in these cases, the addition of pelvic screw (iliac screw) fixation has gained in popularity. Pelvic screw fixation has also been used in cases where sacral screw fixation is not possible (e.g., in sacral tumors). Pelvic screw fixation is more straightforward than prior pelvic rod fixation techniques (e.g., the Galveston technique). We describe our technique for pelvic screw fixation and review our experience with this technique. METHODSTwenty consecutive patients who underwent spinal-pelvic fixation were followed over a 3-year period (2004–2007). The patient population consisted of 11 men and 9 women with an average age of 58.8 years. Indications for spinal-pelvic fixation in this series included kyphoscoliosis, lumbosacral pseudoarthrosis, sacral fractures, lumbosacral spondylolisthesis, sacral tumors, and lumbar osteomyelitic fractures. Radiographic outcomes were assessed using flexion-extension x-rays and computed tomographic scans. Clinical outcomes were assessed using Odom's criteria and modified Prolo scale. RESULTSOne patient was lost to radiographic follow-up. One patient died after surgery. The mean follow-up for the remaining patients was 13 months (range, 1–21 mo). Odom's outcomes were rated as good to excellent in 11 (58%), fair in 7 (37%), and poor in 1 (5%) (one patient died). Preoperative and postoperative modified Prolo scores were 10.4 and 12.9, respectively (mean improvement, 2.5). Radiographic fusion across the lumbosacral junction was obtained in 16 (89%) of the 18 patients with follow-up. One patient required revision of a pelvic screw. There was one infection requiring explantation of hardware. CONCLUSIONPelvic screw fixation is a safe and effective technique that provides added structural support to S1 screws in long-segment spinal fusions. Furthermore, pelvic screw fixation provides a distal point of fixation in cases where sacral screw fixation is not possible. The use of polyaxial screws and connectors makes this technique easier than Galveston rod fixation of the pelvis.

[1]  L. Lenke,et al.  Pseudarthrosis in Long Adult Spinal Deformity Instrumentation and Fusion to the Sacrum: Prevalence and Risk Factor Analysis of 144 Cases , 2006, Spine.

[2]  C. Shaffrey,et al.  Degenerative lumbar scoliosis. , 2006, Neurosurgery clinics of North America.

[3]  F. Shen,et al.  A Novel “Four-Rod Technique” for Lumbo-Pelvic Reconstruction: Theory and Technical Considerations , 2006, Spine.

[4]  L. Lenke,et al.  Minimum 5-Year Analysis of L5–S1 Fusion Using Sacropelvic Fixation (Bilateral S1 and Iliac Screws) for Spinal Deformity , 2006, Spine.

[5]  L. Riley,et al.  Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. , 2005, The Journal of bone and joint surgery. American volume.

[6]  P. Newton,et al.  Biomechanical Comparison of Lumbosacral Fixation Using Luque-Galveston and Colorado II Sacropelvic Fixation: Advantage of Using Locked Proximal Fixation , 2005, Spine.

[7]  K. Bridwell.  Utilization of Iliac Screws and Structural Interbody Grafting for Revision Spondylolisthesis Surgery , 2005, Spine.

[8]  J. Kostuik.  Spinopelvic fixation. , 2005, Neurology India.

[9]  R. Heary.  Evaluation and treatment of adult spinal deformity. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. , 2004, Journal of neurosurgery. Spine.

[10]  S. Ondra,et al.  Transforaminal Lumbar Interbody Fusion: Surgical Technique and Results in 24 Patients , 2004, Neurosurgery.

[11]  R. Schwend,et al.  The Pylon Concept of Pelvic Anchorage for Spinal Instrumentation in the Human Cadaver , 2003, Spine.

[12]  Z. Gokaslan,et al.  Thoracolumbopelvic stabilization for the treatment of instability caused by recurrent myxopapillary ependymoma. , 2003, Journal of spinal disorders & techniques.

[13]  N. Lebwohl,et al.  Biomechanical Comparison of Lumbosacral Fixation Techniques in a Calf Spine Model , 2002, Spine.

[14]  R. Andersen,et al.  Advantage of Pedicle Screw Fixation Directed Into the Apex of the Sacral Promontory Over Bicortical Fixation: A Biomechanical Analysis , 2002, Spine.

[15]  L. Lenke,et al.  Minimum 2-Year Analysis of Sacropelvic Fixation and L5–S1 Fusion Using S1 and Iliac Screws , 2001, Spine.

[16]  R. Winter,et al.  Extension of Fusions to the Pelvis in Idiopathic Scoliosis , 2001, Spine.

[17]  Z. Gokaslan,et al.  Spinal-pelvic fixation in patients with lumbosacral neoplasms. , 2000, Journal of neurosurgery.

[18]  L. Lenke,et al.  Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. , 1999, Spine.

[19]  M. Aebi,et al.  The ‘MW’ sacropelvic construct: an enhanced fixation of the lumbosacral junction in neuromuscular pelvic obliquity , 1999, European Spine Journal.

[20]  M. Aebi,et al.  Modification of the original Luque technique in the treatment of Duchenne's neuromuscular scoliosis. , 1997, Journal of pediatric orthopedics.

[21]  Z. Gokaslan,et al.  Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. , 1997, Journal of neurosurgery.

[22]  L. Miladi,et al.  Iliosacral Screw Fixation for Pelvic Obliquity in Neuromuscular Scoliosis: A Long‐Term Follow‐Up Study , 1997, Spine.

[23]  J. Lotz,et al.  Biomechanical Analysis of Lumbosacral Fixation , 1996, Spine.

[24]  E. Benzel,et al.  Sacral fixation using iliac instrumentation and a variable-angle screw device. Technical note. , 1994, Journal of neurosurgery.

[25]  S. Glassman,et al.  Technique and Results of Fixation to the Sacrum with Iliosacral Screws , 1992, Spine.

[26]  B. Allen,et al.  The Galveston experience with L-rod instrumentation for adolescent idiopathic scoliosis. , 1988, Clinical orthopaedics and related research.

[27]  R. Winter,et al.  Fusion to the Sacrum for Nonparalytic Scoliosis in the Adult , 1986, Spine.

[28]  B. Allen,et al.  The Galveston Technique of Pelvic Fixation with L-Rod Instrumentation of the Spine , 1984, Spine.

[29]  J. Kostuik,et al.  Spinal Fusions to the Sacrum in Adults with Scoliosis , 1983, Spine.