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Abstract
Objectives
We wanted to assess the stability of distal instrumentation using the bilateral S1 and sacral alar screws for the treatment of degenerative lumbar deformity.
Summary of the Literature Review
Various instrumentation methods have been introduced for increasing the strength of lumbosacral fusion. However, there are not many clinical studies that have evaluated the effectiveness of a sub-S1 alar screw for treating degenerative lumbar deformity surgery.
Materials and Methods
A total of 39 patients with degenerative lumbar deformity were treated by long fusion and we retrospectively analyzed these patients after a minimum follow-up of 1 year. All the patients underwent an operation with distal instrumentation using either bilateral S1 screws alone (the S1 group) or additional bilateral sub-S1 sacral alar screws (the SA group). There were 19 patients in the S1 group and 20 patients in the SA group. The stability of the distal instrumentation was assessed by breakage or backout of a rod and/or screws based on simple radiography.
Results
Instability of the distal instrumentation was detected in 6 cases (32%) in the S1 group and in 1 case (5%) in the SA group. The SA group had a more stability of the distal instrumentation than that of the S1 group with a significant difference (P<0.05). Distal instrumentation was unstable in 6 (19%) of the 32 cases with an anterior metal cage through posterior interbody fusion at L5-S1 and in 1(14%) of 7 cases without it at L5-S1. There was no significant difference in the stability of distal instrumentation in each group according to whether or not their L5-S1 was treated with an interbody cage (P>0.05).
REFERENCES
1.Hibbs RA. An operation for progressive spinal deformities: a preliminary report of three cases from the service of the orthopaedic hospital. 1911. Clin Orthop Relat Res. 2007. 460:17–20.
2.Camp JF., Caudle R., Ashmun RD., Roach J. Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study. Spine. 1990. 15:932–41.
3.DePalma AF., Rothman RH. The nature of pseudarthrosis. Clin Orthop Relat Res. 1968. 59:113–8.
4.Cleveland M., Bosworth DM., Thompson FR. Pseudarthrosis in the lumbosacral spine. J Bone Joint Surg Am. 1948. 30:302–12.
5.Devlin VJ., Boachie-Adjei O., Bradford DS., Ogilvie JW., Transfeldt EE. Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation. J Spinal Disord. 1991. 4:1–14.
6.Kornblatt MD., Casey MP., Jacobs RR. Internal fixation in lumbosacral spine fusion. A biomechanical and clinical study. Clin Orthop Relat Res. 1986. 203:141–50.
7.Kim YJ., Bridwell KH., Lenke LG., Cho KJ., Edwards CC 2nd., Rinella AS. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg Am. 2006. 88:721–8.
8.Kim EH., Kim HJ. Long Segment Fusion to L5 Vertebra and Sacral Vertebra in Degenerative Lumbar Spine. J Korean Soc Spine Surg. 2002. 9:216–22.
9.Shin BJ., Kim KJ., Cho YB., Kim YI. Radiologic Results of Posterior Lumbosacral Fixation according to Sacral Fixation Methods: Single Screw vs Double Screws. J Korean Soc Spine Surg. 2000. 7:15–21.
10.Kostuik JP., Errico TJ., Gleason TF. Techniques of internal fixation for degenerative conditions of the lumbar spine. Clin Orthop Relat Res. 1986. 203:219–31.
11.La Grone MO. Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am. 1988. 19:383–93.
12.Lagrone MO., Bradford DS., Moe JH., Lonstein JE., Winter RB., Ogilvie JW. Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am. 1988. 70:569–80.
13.Kim EH., Cho DY., Kim JH. A Clinical Analysis of Long Segment Fusion with Pedicle Screw in Degenerative Lumbar Spine. J Korean Soc Spine Surg. 1999. 6:388–96.
14.McCord DH., Cunningham BW., Shono Y., Myers JJ., McAfee PC. Biomechanical analysis of lumbosacral fixation. Spine. 1992. 17:S235–43.
15.Kuklo TR., Bridwell KH., Lewis SJ, et al. Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine. 2001. 26:1976–83.
16.Lowe T., Berven SH., Schwab FJ., Bridwell KH. The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine. 2006. 31:S119–25.
17.Carlson GD., Abitbol JJ., Anderson DR, et al. Screw fixation in the human sacrum. An in vitro study of the biomechanics of fixation. Spine. 1992. 17:S196–203.
18.Smith SA., Abitbol JJ., Carlson GD., Anderson DR., Taggart KW., Garfin SR. The effects of depth of penetration, screw orientation, and bone density on sacral screw fixation. Spine. 1993. 18:1006–10.
19.Kostuik JP., Valdevit A., Chang HG., Kanzaki K. Biomechanical testing of the lumbosacral spine. Spine. 1998. 23:1721–8.
20.Early S., Mahar A., Oka R., Newton P. Biomechanical comparison of lumbosacral fixation using Luque-Galveston and Colorado II sacropelvic fixation: advantage of using locked proximal fixation. Spine. 2005. 30:1396–401.
21.Lebwohl NH., Cunningham BW., Dmitriev A, et al. Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine. 2002. 27:2312–20.
22.Tis JE., Helgeson M., Lehman RA., Dmitriev AE. A biomechanical comparison of different types of lumbopelvic fixation. Spine. 2009. 34:E866–72.
23.Tsuchiya K., Bridwell KH., Kuklo TR., Lenke LG., Baldus C. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine. 2006. 31:303–8.
24.Chang TL., Sponseller PD., Kebaish KM., Fishman EK. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine. 2009. 34:436–40.
25.O'Brien JR., Yu WD., Bhatnagar R., Sponseller P., Kebaish KM. An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine. 2009. 34:E439–42.
26.Leong JC., Lu WW., Zheng Y., Zhu Q., Zhong S. Comparison of the strengths of lumbosacral fixation achieved with techniques using one and two triangulated sacral screws. Spine. 1998. 23:2289–94.
27.Kim JH., Horton W., Hamasaki T., Freedman B., Whitesides TE., Hutton WC. Spinal Instrumentation for Sacral-pelvic Fixation: A Biomechanical Comparison Between Constructs Ending With Either S2 Bicortical, Bitriangulated Screws or Iliac Screws. J Spinal Disord Tech. 2010.
28.Ebraheim NA., Lu J., Yang H., Heck BE., Yeasting RA. Anatomic considerations of the second sacral vertebra and dorsal screw placement. Surg Radiol Anat. 1997. 19:353–7.
Fig. 1.
A 67 year-old female with degenerative lumbar scoliosis had a lumbar coronal deformity of 30°. (A, B) She was treated by pedicle screw fixation from T10 to S1 and sub-S1 alar screw. Posterior interbody fusion using metal cage was performed on L3-4 and L5-S1. Her deformity was corrected to 5° with distal instrumentation stable in the radiographs taken one and a half year after surgery. (C, D)
Table 1.
Demographics and etiologic diagnosis
Table 2.
Coronal curve magnitude in degenerative lumbar scoliosis patients
Table 3.
Sagittal balance magnitude in patients w with sagittal imbalance
Table 4.
Stability of distal instrumentation between S1 screw alone fixation versus additional sacral alar screw fixation
| Distal instrumentation | S1 screw alone (n=19) | Sacral alar screw (n=20) |
|---|---|---|
| Stable | 13 | 19 |
| Unstable | 6 | 1 |
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