The Incidence of Iliac Screw-Related Complications After Long Fusion Surgery in Patients with Adult Spinal Deformity

Abstract Background: To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.Methods: A retrospective review of consecutive patients underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change <5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.Results: A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26, 39.8 ± 13.8) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9, 30.3 ± 9.9) (p<0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p<0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p<0.05) and (16.1% vs 3.6%, p<0.05).Conclusions: IS fixation showed a greater change in LL and ULL than S2AI fixation in ASD surgery. PI may be changed under certain circumstances.

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Posterior instrumented fusion surgery for adult spinal deformity: Correction rate and total balance

Journal of Craniovertebral Junction and Spine ◽

10.4103/jcvjs.jcvjs_42_19 ◽

2019 ◽

Vol 10 (2) ◽

pp. 100

Author(s):

Toru Yamagata ◽

Herve Chataigner ◽

Pierre-Marie Longis ◽

Toshihiro Takami ◽

Joël Delecrin

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Fusion Surgery ◽

Instrumented Fusion ◽

Correction Rate ◽

Posterior Instrumented Fusion

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Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change

Journal of Neurosurgery Spine ◽

10.3171/2017.9.spine17525 ◽

2018 ◽

Vol 29 (1) ◽

pp. 59-67 ◽

Cited By ~ 7

Author(s):

Yu Yamato ◽

Tomohiko Hasegawa ◽

Sho Kobayashi ◽

Tatsuya Yasuda ◽

Daisuke Togawa ◽

...

Keyword(s):

Spinal Deformity ◽

Revision Surgery ◽

Treatment Strategy ◽

Time Course ◽

Clinical Symptoms ◽

Adult Spinal Deformity ◽

Nonoperative Treatment ◽

Local Alignment ◽

Fusion Surgery

OBJECTIVEDespite the significant incidence of rod fractures (RFs) following long-segment corrective fusion surgery, little is known about the optimal treatment strategy. The objectives of this study were to investigate the time course of clinical symptoms and treatments in patients with RFs following adult spinal deformity (ASD) surgery and to establish treatment recommendations.METHODSThis study was a retrospective case series of patients with RFs whose data were retrieved from a prospectively collected single-center database. The authors reviewed the cases of 304 patients (mean age 62.9 years) who underwent ASD surgery. Primary symptoms, time course of symptoms, and treatments were investigated by reviewing medical records. Standing whole-spine radiographs obtained before and after RF development and at last follow-up were evaluated. Osseous union was assessed using CT scans and intraoperative findings.RESULTSThere were 54 RFs in 53 patients (mean age 68.5 years [range 41–84 years]) occurring at a mean of 21 months (range 6–47 months) after surgery. In 1 patient RF occurred twice, with each case at a different time and level, and the symptoms and treatments for these 2 RFs were analyzed separately (1 case of revision surgery and 1 case of nonoperative treatment). The overall rate of RF observed on radiographs after a minimum follow-up of 1 year was 18.0% (54 of 300 cases). The clinical symptoms at the time of RF were pain in 77.8% (42 of 54 cases) and no onset of new symptoms in 20.5% (11 of 54 cases). The pain was temporary and had subsided in 19 of 42 cases (45%) within 2 weeks. In 36 of the 54 cases (66.7%) (including the first RF in the patient with 2 RFs), patients underwent revision surgery at a mean of 116 days (range 5–888 days) after diagnosis. In 18 cases patients received only nonoperative treatment as of the last follow-up, including 17 cases in which the patients experienced no pain and no remarkable progression of deformity (mean 18.5 months after RF development).CONCLUSIONSThis analysis of 54 RFs in 53 patients following corrective fusion surgery for ASD demonstrates a relationship between symptoms and alignment change. Revision surgeries were performed in a total of 36 cases. Nonoperative care was offered in 18 (33.3%) of 54 cases at the last follow-up, with no additional symptoms in 17 of the 18 cases. These data offer useful information regarding informed decision making for patients in whom an RF occurs after ASD surgery.

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Improvement of pulmonary dysfunction in patients with severe adult spinal deformity after corrective spinal fusion surgery

Case Studies in Surgery ◽

10.5430/css.v4n2p15 ◽

2018 ◽

Vol 4 (2) ◽

pp. 15

Author(s):

Yuki Mihara ◽

Tomohiko Hasegawa ◽

Yu Yamato ◽

Go Yoshida ◽

Sho Kobayashi ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pulmonary Function ◽

Cobb Angle ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Low Back ◽

Pulmonary Dysfunction ◽

Fusion Surgery ◽

Spinal Fusion Surgery

In some cases of adolescent idiopathic scoliosis, corrective surgery can improve pulmonary function. However, the effectiveness of corrective surgery in improving pulmonary function in adult spinal deformity (ASD) has not been reported. Therefore, the purpose of our study was to investigate the recovery of pulmonary function after corrective fusion surgery in 4 patients with severe ASD and associated pulmonary dysfunction. The first patient was a 42-year-old woman with spondylo-epiphyseal dysplasia, whose main presenting complaint was dyspnea. As a result of her respiratory dysfunction, associated with her severe spinal deformity, she required Home Oxygen Therapy (HOT). Prior to surgery, her %vital capacity (VC) was 25%, with a kyphosis angle of 170°. The second patient was a 55-year-old woman with a history of acromegaly, who presented with low back pain. Prior to surgery, she had a %VC of 48% and a Cobb angle of 85°. The third patient was a 59-year-old woman with adolescent idiopathic scoliosis, which had been previously treated, and who was now experiencing increasing low back pain. Prior to surgery, she had a %VC of 58% and a Cobb angle of 87°. The fourth patient was a 60-year-old man, with a history of tuberculous spine, who presented with low back pain. Prior to surgery, his %VC of 75% and Cobb angle of 100°. Pulmonary function improved after corrective fusion surgery in all cases. Halo traction with respiratory rehabilitation should be recommended before corrective spinal fusion surgery for patients with severe ASD and pulmonary dysfunction.

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S-1 and S-2-alar-iliac screw fixation via intraoperative navigation

Neurosurgical FOCUS ◽

10.3171/2016.2.focusvid.1693 ◽

2016 ◽

Vol 41 (videosuppl1) ◽

pp. 1

Author(s):

Martin H. Pham ◽

Andre M. Jakoi ◽

Patrick C. Hsieh

Keyword(s):

Spinal Deformity ◽

Screw Fixation ◽

Adult Spinal Deformity ◽

Intraoperative Navigation ◽

Case Presentation ◽

Adult Deformity ◽

Sacropelvic Fixation ◽

Fixation Techniques ◽

Iliac Screw ◽

Bicortical Screw

Adult deformity patients often require fixation to the sacrum and pelvis for construct stability and improved fusion rates. Although certain sacropelvic fixation techniques can be challenging, the availability of intraoperative navigation has made many of these techniques more feasible. In this video case presentation, the authors demonstrate the techniques of S-1 bicortical screw and S-2-alar-iliac screw fixation under intraoperative navigation in a 67-year-old female. This instrumentation placement was part of an overall T-10–pelvis construct for the correction of adult spinal deformity.The video can be found here: https://youtu.be/3HZo-80jQr8.

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Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001058 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sahitya K. Denduluri ◽

Jayme C.B. Koltsov ◽

Chason Ziino ◽

Nicole Segovia ◽

Craig McMains ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Posterior Fusion ◽

Dissimilar Metals ◽

Complication Rates ◽

Fusion Surgery

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Stopping at Sacrum Versus Nonsacral Vertebra in Long Fusion Surgery for Adult Spinal Deformity: Meta-Analysis of Revision with Minimum 2-Year Follow-Up

World Neurosurgery ◽

10.1016/j.wneu.2018.12.102 ◽

2019 ◽

Vol 124 ◽

pp. e380-e386 ◽

Cited By ~ 1

Author(s):

Songfeng Chen ◽

Ming Luo ◽

Yongkui Wang ◽

Hongjian Liu

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Meta Analysis ◽

Fusion Surgery

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Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical spinal fusion surgery: a nationwide analysis of 52,818 patients

The Spine Journal ◽

10.1016/j.spinee.2018.03.020 ◽

2018 ◽

Vol 18 (10) ◽

pp. 1861-1866 ◽

Cited By ~ 6

Author(s):

David N. Bernstein ◽

Etka Kurucan ◽

Emmanuel N. Menga ◽

Robert W. Molinari ◽

Paul T. Rubery ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Spinal Fusion ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Fusion Surgery ◽

Spinal Fusion Surgery

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The lexicon of multirod constructs in adult spinal deformity: a concise description of when, why, and how

Journal of Neurosurgery Spine ◽

10.3171/2021.10.spine21745 ◽

2021 ◽

pp. 1-7

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Pedicle Screws ◽

Lumbosacral Junction ◽

Coronal Balance ◽

Clinical Scenarios ◽

Iliac Screw ◽

Correction Surgery ◽

Rod Fracture ◽

Concise Description

The use of multirod constructs in the setting of adult spinal deformity (ASD) began to prevent rod fracture and pseudarthrosis near the site of pedicle subtraction osteotomies (PSOs) and 3-column osteotomies (3COs). However, there has been unclear and inconsistent nomenclature, both clinically and in the literature, for the various techniques of supplemental rod implantation. In this review the authors aim to provide the first succinct lexicon of multirod constructs available for the treatment of ASD, providing a universal nomenclature and definition for each type of supplementary rod. The primary rod of ASD constructs is the longest rod that typically spans from the bottom of the construct to the upper instrumented vertebrae. The secondary rod is shorter than the primary rod, but is connected directly to pedicle screws, albeit fewer of them, and connects to the primary rod via lateral connectors or cross-linkers. Satellite rods are a 4-rod technique in which 2 rods span only the site of a 3CO via pedicle screws at the levels above and below, and are not connected to the primary rod (hence the term “satellite”). Accessory rods are connected to the primary rods via side connectors and buttress the primary rod in areas of high rod strain, such as at a 3CO or the lumbosacral junction. Delta rods span the site of a 3CO, typically a PSO, and are not contoured to the newly restored lordosis of the spine, thus buttressing the primary rod above and below a 3CO. The kickstand rod itself functions as an additional means of restoring coronal balance and is secured to a newly placed iliac screw on the side of truncal shift and connected to the primary rod; distracting against the kickstand then helps to correct the concavity of a coronal curve. The use of multirod constructs has dramatically increased over the last several years in parallel with the increasing prevalence of ASD correction surgery. However, ambiguity persists both clinically and in the literature regarding the nomenclature of each supplemental rod. This nomenclature of supplemental rods should help unify the lexicon of multirod constructs and generalize their usage in a variety of scientific and clinical scenarios.

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