Persistent Iliosacral Joint Syndrome following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity

2018 ◽  
Vol 80 (01) ◽  
pp. 015-025 ◽  
Author(s):  
Daniela Diesing ◽  
Joerg Franke ◽  
Sven Tschoeke ◽  
Rolf Schultheiß ◽  
Kai Scheufler
Keyword(s):  
Logistic Regression ◽  
Spinal Deformity ◽  
Sacroiliac Joint ◽  
Roc Analysis ◽  
Pelvic Incidence ◽  
Short Form ◽  
Close Association ◽  
Adult Spinal Deformity ◽  
Interventional Treatment ◽  
Pelvic Fixation

Background and Objective Persistent sacroiliac joint syndrome (PSIJS) may complicate adult spinal deformity surgery (ASDS). This study assesses the relationship between clinical/morphometric parameters and PSIJS following ASDS including pelvic fixation and the therapeutic efficacy of secondary iliosacral fusion (ISF). Methods Perioperative health-related quality of life (HRQOL) outcomes (Oswestry Disability Index, Short Form 12-item health survey, version 2 scores) at 6, 12, and 24 months, and radiographic studies were analyzed retrospectively in a cohort of 71 consecutive patients undergoing ASDS. PSIJS was confirmed in nine individuals (12.7%) by placebo-controlled dual sacroiliac joint (SIJ) blocks. The relationships between global and regional spinopelvic morphometry, PSIJS, and HRQOL outcomes were assessed by logistic regression and receiver operating characteristic curve (ROC) analysis. Results PSIJS, independently causing significantly reduced improvement in HRQOL scores (p < 0.001) 6 months postoperatively, warranted secondary ISF in nine patients (12.7%) within 12 months of index surgery, without evidence of progressive SIJ arthrosis, pseudarthrosis, or hardware issues. Eight of nine patients undergoing secondary ISF reported≥ 70% pain reduction at 24 months. Logistic regression/ROC analysis revealed a close association between PSIJS and nonharmonious postoperative L4–S1 fractional lordosis (p < 0.0001), pelvic incidence angle > 53 degrees, hip arthrosis, and preexistent advanced SIJ arthrosis (p < 0.01). Conclusion PSIJS may negatively impact the clinical outcome of ASDS. Recurrent preoperative SIJ syndrome requiring interventional treatment, preexisting hip and SIJ arthrosis, insufficient restoration of L4–S1 fractional lordosis, and high pelvic incidence predispose to PSIJS. PSIJS may potentially be avoided by restoring physiologic lumbosacral geometry and S2 sacral alar-iliac screw fixation during index surgery. Secondary ISF appears to be effective in reducing pain and physical impairment due to PSIJS.

Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity

Neurosurgery ◽  
2016 ◽  
Vol 78 (6) ◽  
pp. 851-861 ◽  
Author(s):  
◽  
Justin S. Smith ◽  
Virginie Lafage ◽  
Christopher I. Shaffrey ◽  
Frank Schwab ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Short Form ◽  
Adult Spinal Deformity ◽  
Research Society ◽  
Nonoperative Treatment ◽  
Leg Pain ◽  
Scoliosis Research Society

Abstract BACKGROUND: High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed. OBJECTIVE: To compare outcomes of operative and nonoperative treatment for ASD. METHODS: This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age &gt;18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence–to–lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up. RESULTS: Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P &lt; .001) and had worse deformity based on pelvic tilt, pelvic incidence–to–lumbar lordosis mismatch, and sagittal vertical axis (P ⩽ .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P &lt; .001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P &lt; .001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P &lt; .001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had ≥1 complications. CONCLUSION: Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability.

scholarly journals A Comprehensive Analysis of the Behavior of Pelvic Incidence After Different Posterior Spinal Procedures in Elderly Patients With Spinal Deformity

2021 ◽  
pp. 219256822199668
Author(s):  
Weiguo Zhu ◽  
Yu Wang ◽  
Chao Kong ◽  
Xiangyao Sun ◽  
Fumin Pan ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Deformity ◽  
Pelvic Incidence ◽  
Lumbar Fusion ◽  
Adult Spinal Deformity ◽  
Sagittal Vertical Axis ◽  
Pelvic Fixation ◽  
Group A ◽  
Group B ◽  
Sagittal Deformity

Study Design: A retrospective case-control study. Objective: To evaluate the behavior of pelvic incidence (PI) after different posterior spinal procedures in elderly patients with adult spinal deformity (ASD), to determine the potential associated factors with the variability in PI after spinal surgery and to comprehensively analyze its mechanisms. Methods: Elderly patients underwent long fusion to sacrum with and without pelvic fixation were assigned to Group L+P and Group L-P, respectively. In Group L-P, those with severe sagittal deformity were selected as Group A. 20 elderly patients with severe sagittal deformity underwent short lumbar fusion were included as Group B. The following radiographic parameters were evaluated: thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), PI-LL, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and pelvic parameters. PI changing more than 5° (△PI > 5°) was considered as substantially changed. Results: For the whole cohort and in Group L+P, PI were not substantially changed (△PI ≤ 5°) after surgery. Besides the severer sagittal malalignment in patients with △PI > 5° in Group L-P, relatively larger mean age, greater proportion of female and lower preoperative PI were found than those in patients with △PI ≤ 5°. 70.8% of patients had substantial increase of PI in Group A, while only 10% of patients had in Group B ( P < 0.001). Conclusion: PI behaves differently under different conditions in elderly ASD patients. Besides severe sagittal deformity, aging, female and low preoperative PI are also the potential risk factors of PI increasing after long fusion to sacrum.

Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Neurosurgery ◽  
2020 ◽  
Author(s):  
Se-Jun Park ◽  
Jin-Sung Park ◽  
Yunjin Nam ◽  
Tae-Hoon Yum ◽  
Youn-Taek Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Scan ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Study Cohort ◽  
Related Factors ◽  
Fixation Failure ◽  
Failure Group ◽  
Pelvic Fixation ◽  
Spinopelvic Fixation

Abstract BACKGROUND Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors. OBJECTIVE To classify the types of SPFF and investigate its risk factors, including the fusion status at L5-S1 on CT scan. METHODS The study cohort consisted of ninety-eight ASD patients who underwent more than 4-level fusions to the sacrum with interbody fusion at L5-S1. Patients with SPFF were divided into the two groups: above-S1 and below-S1 failure groups. The patient, surgical, and radiographic variables in each group were compared to those of the no-failure group. The L5-S1 fusion status was assessed using 2-yr computed tomography (CT) scan. Univariate and multivariate analyses were performed to determine the risk factors for each failure group. RESULTS The mean age was 68.5 yr. Follow-up duration was 55.7 mo. The SPFF developed in 46 (46.9%) patients at 32.7 mo postoperatively. There were 15 patients in the above-S1 failure group and 31 patients in the below-S1 failure group. Multivariate analysis revealed that nonunion at L5-S1 was a single risk factor for above-S1 failure. In contrast, the risk factors for below-S1 failure included a greater number of fused segments and postoperative less thoracic kyphosis. CONCLUSION SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.

Sacroiliac Joint Arthropathy in Adult Spinal Deformity Patients with Long Constructs to the Pelvis

2021 ◽  
pp. 106593
Author(s):  
Mohammad Hassan A. Noureldine ◽  
Elliot Pressman ◽  
Jay I. Kumar ◽  
Gleb Zavadskiy ◽  
Nam D. Tran ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sacroiliac Joint ◽  
Adult Spinal Deformity

Loss of Pelvic Incidence Correction After Long Fusion Using Iliac Screws for Adult Spinal Deformity

Spine ◽  
2019 ◽  
Vol 44 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Hiroki Oba ◽  
Shigeto Ebata ◽  
Jun Takahashi ◽  
Shota Ikegami ◽  
Kensuke Koyama ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Pelvic Incidence ◽  
Adult Spinal Deformity ◽  
Iliac Screws

scholarly journals Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery

2020 ◽  
pp. 219256822096075
Author(s):  
Jonathan Charles Elysee ◽  
Francis Lovecchio ◽  
Renaud Lafage ◽  
Bryan Ang ◽  
Alex Huang ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Lumbar Fusion ◽  
Adult Spinal Deformity ◽  
Multilinear Regression ◽  
Sagittal Vertical Axis ◽  
Type Curve ◽  
Scoliosis Research Society ◽  
Correlation Analyses

Study Design: Retrospective cohort study. Objective: To investigate correlations between preoperative supine imaging and postoperative alignment. Methods: A retrospective review was conducted of a single-institution database of patients with adult spinal deformity (ASD). Patients were stratified by fusion location in the lumbar or thoracic spine. Outcomes of interest were postoperative lumbar lordosis (LL) and thoracic kyphosis (TK). Sagittal alignment parameters were compared and correlation analyses were performed. Multilinear stepwise regression was conducted to identify independent predictors of postoperative LL or TK. Regression analyses were repeated within the lumbar and thoracic fusion cohorts. Results: A total of 99 patients were included (mean age 63.2 years, 83.1% female, mean body mass index 27.3 kg/m2). Scoliosis Research Society classification demonstrated moderate to severe sagittal and/or coronal deformity (pelvic tile modifier, 18.2% ++; sagittal vertical axis, 27.3% ++, pelvic incidence minus lumbar lordosis mismatch, 29.3% ++, SRS type, 29.3% N type curve and 68.7% L or D type curve). A total of 73 patients (73.7%) underwent lumbar fusion and 50 (50.5%) underwent thoracic fusion. Correlation analyses demonstrated a significant association between pre- and postoperative LL and TK. Multilinear regression demonstrated that LL supine and pelvic incidence were significant predictors of postoperative LL ( r 2 = 0.568, P < .001). LL supine, TK supine, and age were significant predictors of postoperative TK ( r 2 = 0.490, P < .001). Conclusion: Preoperative supine films are superior to standing in predicting postoperative alignment at 1-year follow-up. Anticipation of undesired alignment changes through supine imaging may be useful in mitigating the risk of iatrogenic malalignment.

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