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European Spine Journal

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01-05-2014 | Original Article

Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease

Authors: T. Finger, S. Bayerl, J. Onken, M. Czabanka, J. Woitzik, P. Vajkoczy

Published in: European Spine Journal | Issue 5/2014

Abstract

Study design

Retrospective study.

Objective

For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative spine disease.

Methods

A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5–S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications.

Results

The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous spine surgeries, or postoperative complication rate. The incidence of L5–S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate).

Conclusion

The surgical treatment of multilevel degenerative spine disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.

Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery—the case for restraint. N Engl J Med 350:722–726PubMedCrossRef

Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C (2006) Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine 31:303–308PubMedCrossRef

Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine 31:2329–2336PubMedCrossRef

Early S, Mahar A, Oka R, Newton P (2005) Biomechanical comparison of lumbosacral fixation using Luque-Galveston and Colorado II sacropelvic fixation: advantage of using locked proximal fixation. Spine 30:1396–1401PubMedCrossRef

Tomlinson T, Chen J, Upasani V, Mahar A (2008) Unilateral and bilateral sacropelvic fixation result in similar construct biomechanics. Spine 33:2127–2133PubMedCrossRef

Kebaish KM (2010) Sacropelvic fixation: techniques and complications. Spine 35:2245–2251PubMedCrossRef

Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG (2001) Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine 26:1976–1983PubMedCrossRef

Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D, Study Group on S (2012) Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine 37:693–700PubMedCrossRef

Allen BL Jr, Ferguson RL (1982) The Galveston technique for L rod instrumentation of the scoliotic spine. Spine 7:276–284PubMedCrossRef

10.

Allen BL Jr, Ferguson RL (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine 9:388–394PubMedCrossRef

11.

Schwend RM, Sluyters R, Najdzionek J (2003) The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine 28:542–547PubMed

12.

Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine 27:776–786PubMedCrossRef

13.

D C (1991) A new device for pelvic fixation for spinal surgery: the sacral block. In: 8th proceeding of the international congress of cotrel-dubousset instrumentation. Minneapolis, MN

14.

Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, Boachie-Adjei O, Wagner TA (2002) Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine 27:2312–2320PubMedCrossRef

15.

Hyun SJ, Rhim SC, Kim YJ, Kim YB (2010) A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion. J Korean Neurosurg Soc 48:347–353PubMedCentralPubMedCrossRef

16.

Mak PH, Campbell RC, Irwin MG, American Society of A (2002) The ASA physical status classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care 30:633–640PubMed

17.

Crawford CH 3rd, Carreon LY, Bridwell KH, Glassman SD (2012) Long fusions to the sacrum in elderly patients with spinal deformity. Eur Spine J 21:2165–2169PubMedCentralPubMedCrossRef

18.

Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine 34:2171–2178PubMedCrossRef

19.

Li G, Passias P, Kozanek M, Fu E, Wang S, Xia Q, Li G, Rand FE, Wood KB (2009) Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine 34:2165–2170PubMedCrossRef

20.

Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K, Spinal Deformity Study G (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65:86–93 (discussion 93–84)PubMedCrossRef

21.

Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH, Spinal Deformity Study G (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36:817–824PubMedCrossRef

22.

Alegre GM, Gupta MC, Bay BK, Smith TS, Laubach JE (2001) S1 screw bending moment with posterior spinal instrumentation across the lumbosacral junction after unilateral iliac crest harvest. Spine 26:1950–1955PubMedCrossRef

23.

Peelle MW, Lenke LG, Bridwell KH, Sides B (2006) Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: galveston rod versus iliac and lumbosacral screws. Spine 31:2392–2398 (discussion 2399)PubMedCrossRef

24.

Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK, Kostial PN, Tambe A, Asher MA, Growing Spine Study G (2008) Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 33:984–990PubMedCrossRef

25.

Sponseller PD, Yang JS, Thompson GH, McCarthy RE, Emans JB, Skaggs DL, Asher MA, Yazici M, Poe-Kochert C, Kostial P, Akbarnia BA (2009) Pelvic fixation of growing rods: comparison of constructs. Spine 34:1706–1710PubMedCrossRef

26.

Harimaya K, Mishiro T, Lenke LG, Bridwell KH, Koester LA, Sides BA (2011) Etiology and revision surgical strategies in failed lumbosacral fixation of adult spinal deformity constructs. Spine 36:1701–1710PubMedCrossRef

27.

Leong JC, Lu WW, Zheng Y, Zhu Q, Zhong S (1998) Comparison of the strengths of lumbosacral fixation achieved with techniques using one and two triangulated sacral screws. Spine 23:2289–2294PubMedCrossRef

28.

Stovall DO Jr, Goodrich JA, Lundy D, Standard SC, Joe C, Preston CD (1997) Sacral fixation technique in lumbosacral fusion. Spine 22:32–37PubMedCrossRef

29.

Kim YJ, Bridwell KH, Lenke LG, Cho KJ, Edwards CC 2nd, Rinella AS (2006) Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg Am 88:721–728PubMedCrossRef

30.

Wang MY (2012) Percutaneous iliac screws for minimally invasive spinal deformity surgery. Minim Invasive Surg 2012:173685PubMedCentralPubMed

31.

Wang MY, Williams S, Mummaneni PV, Sherman JD (2012) Minimally invasive percutaneous iliac screws: initial 24 case experience with CT confirmation. J Spinal Disord Tech. doi:10.1097/BSD.0b013e3182733c43 PubMedCentral

32.

Tumialan LM, Mummaneni PV (2008) Long-segment spinal fixation using pelvic screws. Neurosurgery 63:183–190PubMedCrossRef

33.

Pateder DB, Gonzales RA, Kebaish KM, Cohen DB, Chang JY, Kostuik JP (2008) Short-term mortality and its association with independent risk factors in adult spinal deformity surgery. Spine 33:1224–1228PubMedCrossRef

34.

Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine 32:2764–2770PubMedCrossRef

35.

Kim KT, Lee SH, Suk KS, Lee JH, Jeong BO (2012) Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine 37:1667–1675PubMedCrossRef

Title: Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease
Authors: T. Finger
S. Bayerl
J. Onken
M. Czabanka
J. Woitzik
P. Vajkoczy
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 5/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3165-6

At a glance: The STEP trials

Springer Medicine

Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease

Abstract

Study design

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Study design

Objective

Methods

Results

Conclusion

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