An early experience of lumbopelvic fixation techniques at Alexandria University

Abstract Background The aim of lumbopelvic fixation is to obtain a solid fusion across the lumbosacral junction. There are many indications for lumbopelvic fixation, namely, spinal deformity in cases requiring long segment fusion, pelvic obliquity, pseudarthrosis at the lumbosacral junction, infection or osteolytic tumors, and pathologic fractures. The classical iliac screws should be contained within the iliac bone but have some disadvantages: excessive soft tissue dissection needed for accurate insertion, screw prominence with patient discomfort, and usually, a side connector is needed to connect the iliac screws to the rest of the construct. Lumbopelvic fixation by insertion of S2 alar-iliac (S2AI) screws was recently described to overcome these disadvantages. In this study, the authors present the initial results for the evaluation of lumbopelvic fixation through the insertion of S2AI screws in 19 consecutive patients operated in the neurosurgery department at Alexandria University. Objective The aim of the study was to evaluate the efficacy and complications of lumbopelvic fixation through the use of S2 alar-iliac screws. Methods The authors conducted a retrospective cohort study of data collected from the database of patients who underwent lumbopelvic fixation through the insertion of S2AI screws from 2016 to 2019 at a single institution. Results There were 19 patients indicated for lumbopelvic fixation, operated by modern instrumentation systems using lumbar pedicle screws and S2 alar-iliac screws. There were 14 females and 5 males. The mean age at the time of the operation was 38.6 ± 19.4 years with a range from 11 to 65 years. There was a total of 37 S2AI screws, screw diameter was 7mm in all cases regardless of age, and the length of the screws ranged from 50 mm in a young female patient (11 years) to 90 mm in an old male patient (60 years). Two screws were inserted per patient except in one case with congenital scoliosis due to the bad bone quality and the multiple iatrogenic wrong paths. Postoperative VAS score for back pain was greatly improved in all patients after the first 6 months of follow-up from 8 ± 1.5 to 3.5 ± 1.2 (paired t-test = 11.182, P<0.001). All patients had a good spinal range of motion to maintain normal daily activities without any significant restrictions after the first 3 months of follow-up. Immediate postoperative radiological follow-up had revealed 2 cases of posterior pelvic breaches and one case with anterior pelvic breach but without clinical manifestations with no need for revision. Two cases of unilateral screw breakout were observed after the first 6 months of follow-up. Removal of screws after the first 6 months was done in one patient with spondylodiscitis due to the unresolved infection and screw pullout. Conclusion The insertion of S2AI screws is an effective technique for lumbopelvic fixation with a relatively low rate of complications. Pelvic breaches are the commonest complications encountered during the insertion of S2AI screws, although no significant clinical morbidities were reported.

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Total L-5 spondylectomy and reconstruction of the lumbosacral junction

Journal of Neurosurgery Spine ◽

10.3171/spi-07/07/103 ◽

2007 ◽

Vol 7 (1) ◽

pp. 103-111 ◽

Cited By ~ 20

Author(s):

Gary L. Gallia ◽

Daniel M. Sciubba ◽

Ali Bydon ◽

Ian Suk ◽

Jean-Paul Wolinsky ◽

...

Keyword(s):

Vertebral Body ◽

Anterior Approach ◽

Posterior Approach ◽

Pedicle Screws ◽

Allograft Bone ◽

Lumbosacral Junction ◽

Second Stage ◽

Iliac Screws ◽

Vascular Structures

✓The authors describe a technique for total L-5 spondylectomy and reconstruction of the lumbosacral junction. The technique, which involves separately staged posterior and anterior procedures, is reported in two patients harboring neoplasms that involved the L-5 level. The first stage consisted of a posterior approach with removal of all posterior bone elements of L-5 and radical L4–5 and L5–S1 discectomies. Lumbosacral and lumbopelvic instrumentation included pedicle screws as well as iliac screws or a transiliac rod. The second stage consisted of an anterior approach with mobilization of vascular structures, completion of L4–5 and L5–S1 discectomies, and removal of the L-5 vertebral body. Anterior lumbosacral reconstruction included placement of a distractable cage and tension band between L-4 and S-1. Allograft bone was used for fusion in both stages. No significant complications were encountered. At more than 1 year of follow-up, both patients were independently ambulatory, without evidence of recurrent or metastatic disease, and adequate lumbosacral alignment was maintained. The authors conclude that this technique can be safely performed in appropriately selected patients with neoplasms involving L-5.

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Mid- to Long-Term Follow-up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

10.21203/rs.3.rs-99414/v1 ◽

2020 ◽

Author(s):

Zhenchao Xu ◽

Zhen Zhang ◽

Gang Chen ◽

Xiyang Wang

Keyword(s):

Interbody Fusion ◽

Safe Procedure ◽

Lumbosacral Junction ◽

Lumbopelvic Fixation ◽

One Stage ◽

Postural Drainage ◽

Patient Reported ◽

Posterior Debridement

Abstract Background: This retrospective study aimed to evaluate the mid- to long-term outcomes of surgical management of lumbosacral junction tuberculosis in adults. Methods: A total of 38 adult patients were treated by one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. All cases were followed up for at least five years. Clinical and radiographic outcomes were gathered and analyzed.Results: All patients achieved clinical cure at the last follow-up. Erythrocyte sedimentation rates decreased to normal levels within three months postoperatively. Postoperative scores measuring pain (visual analog scale), neurological status (Japanese Orthopedic Association score), and patient quality of life (Oswestry Disability Index) all significantly improved compared to preoperative values. Patient-reported outcomes as measured by Kirkaldy-Willis criteria were excellent in 21 cases, good in 16 cases, and fair in 1 case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7° ± 1.8° to the postoperative values of 26.4° ± 1.4°, with an angle loss of 1.2° ± 0.7° at the last follow-up. Bone fusion occurred on average 12.8 ± 1.9 months after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow-up.Conclusion: For patients with lumbosacral junction TB, a treatment protocol including one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is a relatively nontraumatic and highly safe procedure. It can be used to reconstruct lumbosacral or lumbopelvic stability and facilitate the healing of TB.

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Mid- to Long-Term Follow-up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

10.21203/rs.3.rs-154383/v1 ◽

2021 ◽

Author(s):

Zhenchao Xu ◽

Zhen Zhang ◽

Xiyang Wang ◽

Yilu Zhang ◽

Yunqi Wu

Keyword(s):

Interbody Fusion ◽

Safe Procedure ◽

Lumbosacral Junction ◽

Lumbopelvic Fixation ◽

One Stage ◽

Postural Drainage ◽

Patient Reported ◽

Posterior Debridement

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Fate of S2-Alar-Iliac Screws After 12-Month Minimum Radiographic Follow-up: Preliminary Results

Neurosurgery ◽

10.1227/neu.0000000000001322 ◽

2016 ◽

Vol 80 (1) ◽

pp. 67-72 ◽

Cited By ~ 12

Author(s):

Marcus D. Mazur ◽

Mark A. Mahan ◽

Lubdha M. Shah ◽

Andrew T. Dailey

Keyword(s):

Long Term Results ◽

Screw Loosening ◽

Related Complication ◽

Radiographic Evidence ◽

Lumbopelvic Fixation ◽

Radiographic Outcomes ◽

Iliac Screws ◽

Biomechanical Strength

Abstract BACKGROUND: S2-alar-iliac (S2AI) screws are 1 technique for lumbopelvic fixation to improve fusion rates across the lumbosacral junction that has gained wider acceptance. The S2AI screw crosses the cortical surfaces of the sacroiliac joint (SIJ), which may improve the biomechanical strength of the instrumentation. OBJECTIVE: To report preliminary radiographic outcomes of patients who underwent lumbopelvic fixation with S2AI screws with a minimum 12-month follow-up. METHODS: We retrospectively reviewed adult patients who underwent lumbopelvic fixation with S2AI screws. Patients with computed tomography (CT) scans obtained preoperatively and ≥12 months postoperatively were reviewed to determine whether there was S2AI screw backout or breakage, periscrew lucency, or SIJ degeneration, and to assess L5-S1 fusion status. RESULTS: Twenty-six S2AI screws in 13 patients were evaluated (mean follow-up 24.8 months [14-52 months]). Nine patients had L5-S1 interbody grafts. Partial periscrew lucency was identified in 7 S2AI screws (27%) in 5 patients (38%), and L5-S1 fusion occurred in 92% of patients. L5-S1 nonunion was seen in 1 patient (8%), who had evidence of bilateral screw loosening in the sacral portion. Four patients with screw loosening had an osseous L5-S1 fusion. No patients had radiographic evidence of progression of SIJ degeneration, experienced screw backout or breakage, required reoperation for L5-S1 nonunion, or had S2AI screw-related complication. CONCLUSION: S2AI screws maintained their integrity without causing SIJ degeneration or major screw-related complications in this small retrospective series with short follow-up. Long-term results are needed to evaluate the durability of S2AI screws over time.

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Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm

Journal of Neurosurgery Spine ◽

10.3171/2019.12.spine191148 ◽

2020 ◽

Vol 33 (2) ◽

pp. 225-236 ◽

Cited By ~ 1

Author(s):

Thomas J. Buell ◽

Ulas Yener ◽

Tony R. Wang ◽

Avery L. Buchholz ◽

Chun-Po Yen ◽

...

Keyword(s):

Insufficiency Fracture ◽

Sacral Fracture ◽

Leg Pain ◽

Insufficiency Fractures ◽

Lower Extremity Weakness ◽

Sacral Insufficiency Fracture ◽

Lumbopelvic Fixation ◽

Iliac Screws ◽

Sacral Insufficiency Fractures

OBJECTIVESacral insufficiency fracture after lumbosacral (LS) arthrodesis is an uncommon complication. The objective of this study was to report the authors’ operative experience managing this complication, review pertinent literature, and propose a treatment algorithm.METHODSThe authors analyzed consecutive adult patients treated at their institution from 2009 to 2018. Patients who underwent surgery for sacral insufficiency fractures after posterior instrumented LS arthrodesis were included. PubMed was queried to identify relevant articles detailing management of this complication.RESULTSNine patients with a minimum 6-month follow-up were included (mean age 73 ± 6 years, BMI 30 ± 6 kg/m2, 56% women, mean follow-up 35 months, range 8–96 months). Six patients had osteopenia/osteoporosis (mean dual energy x-ray absorptiometry hip T-score −1.6 ± 0.5) and 3 received treatment. Index LS arthrodesis was performed for spinal stenosis (n = 6), proximal junctional kyphosis (n = 2), degenerative scoliosis (n = 1), and high-grade spondylolisthesis (n = 1). Presenting symptoms of back/leg pain (n = 9) or lower extremity weakness (n = 3) most commonly occurred within 4 weeks of index LS arthrodesis, which prompted CT for fracture diagnosis at a mean of 6 weeks postoperatively. All sacral fractures were adjacent or involved S1 screws and traversed the spinal canal (Denis zone III). H-, U-, or T-type sacral fracture morphology was identified in 7 patients. Most fractures (n = 8) were Roy-Camille type II (anterior displacement with kyphosis). All patients underwent lumbopelvic fixation via a posterior-only approach; mean operative duration and blood loss were 3.3 hours and 850 ml, respectively. Bilateral dual iliac screws were utilized in 8 patients. Back/leg pain and weakness improved postoperatively. Mean sacral fracture anterolisthesis and kyphotic angulation improved (from 8 mm/11° to 4 mm/5°, respectively) and all fractures were healed on radiographic follow-up (mean duration 29 months, range 8–90 months). Two patients underwent revision for rod fractures at 1 and 2 years postoperatively. A literature review found 17 studies describing 87 cases; potential risk factors were osteoporosis, longer fusions, high pelvic incidence (PI), and postoperative PI-to–lumbar lordosis (LL) mismatch.CONCLUSIONSA high index of suspicion is needed to diagnose sacral insufficiency fracture after LS arthrodesis. A trial of conservative management is reasonable for select patients; potential surgical indications include refractory pain, neurological deficit, fracture nonunion with anterolisthesis or kyphotic angulation, L5–S1 pseudarthrosis, and spinopelvic malalignment. Lumbopelvic fixation with iliac screws may be effective salvage treatment to allow fracture healing and symptom improvement. High-risk patients may benefit from prophylactic lumbopelvic fixation at the time of index LS arthrodesis.

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Sacroiliac Joint Degeneration After Lumbopelvic Fixation

Global Spine Journal ◽

10.1177/2192568220978235 ◽

2020 ◽

pp. 219256822097823

Author(s):

Hiroaki Nakashima ◽

Tokumi Kanemura ◽

Kotaro Satake ◽

Kenyu Ito ◽

Satoshi Tanaka ◽

...

Keyword(s):

Sacroiliac Joint ◽

Japanese Orthopaedic Association ◽

Degenerative Changes ◽

Lumbosacral Fusion ◽

Lumbopelvic Fixation ◽

Post Surgery ◽

Significant Difference ◽

Iliac Screws ◽

Distal Fixation

Study Design: Retrospective Study. Objectives: Sacroiliac buttress screws (SBS) and S2 alar iliac screws (SAI) are used as distal screws in cases with long fusion to the pelvis. Distal fixation ends, whether exceeding the sacroiliac joint (SIJ), may affect postoperative degenerative changes in the SIJ. The aim of this study was to investigate SIJ degeneration after lumbosacral and lumbopelvic fixation, using SBS and SAI in degenerative spine diseases, respectively. Methods: This study included 70 patients aged ≥50 years with lumbosacral fusion (>3 levels). They were divided into 2 groups (SBS 20 and SAI 50 cases) based on the type of distal screws. Radiographical and clinical data were reviewed with a minimum 2-year follow-up. Radiographical SIJ degeneration was analyzed using computed tomography; clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ). Results: No significant differences were observed in patients’ preoperative characteristics between the 2 groups. The incidence of SIJ degeneration, including osteophyte formation (30.0% and 8.0%, p = 0.03), intraarticular air (75.0% and 16.0%, p < 0.001), and subchondral cyst (20.0% and 2.0%. p = 0.02) in SBS and SAI groups, respectively, at the follow-up, was significantly higher in the SBS group. Although SIJ degenerative changes were significantly different between the SBS and SAI groups, there was no significant difference in VAS and JOABPEQ scores between the groups at 2 years post-surgery. Conclusions: Lumbosacral fusion can cause SIJ degeneration, which is more frequent when SBS are used in fixation to the sacrum.

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Medium‐Term Follow‐Up Outcomes of One‐Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

Orthopaedic Surgery ◽

10.1111/os.13150 ◽

2021 ◽

Author(s):

Zhenchao Xu ◽

Zhen Zhang ◽

Xiyang Wang ◽

Yilu Zhang ◽

Yunqi Wu

Keyword(s):

Lumbosacral Junction ◽

Medium Term ◽

Lumbopelvic Fixation ◽

One Stage

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Monogenic Diabetes: Genetics and Relevance on Diabetes Mellitus Personalized Medicine

Current Diabetes Reviews ◽

10.2174/1573399816666191230114352 ◽

2020 ◽

Vol 16 (8) ◽

pp. 807-819 ◽

Cited By ~ 1

Author(s):

Madalena Sousa ◽

Jácome Bruges-Armas

Keyword(s):

Diabetes Mellitus ◽

Complex Disease ◽

Clinical Manifestations ◽

Neonatal Diabetes ◽

Monogenic Diabetes ◽

Diabetes Genetics ◽

Individualize Treatment

Background: Diabetes mellitus (DM) is a complex disease with significant impression in today's world. Aside from the most common types recognized over the years, such as type 1 diabetes (T1DM) and type 2 diabetes (T2DM), recent studies have emphasized the crucial role of genetics in DM, allowing the distinction of monogenic diabetes. Methods: Authors did a literature search with the purpose of highlighting and clarifying the subtypes of monogenic diabetes, as well as the accredited genetic entities responsible for such phenotypes. Results: The following subtypes were included in this literature review: maturity-onset diabetes of the young (MODY), neonatal diabetes mellitus (NDM) and maternally inherited diabetes and deafness (MIDD). So far, 14 subtypes of MODY have been identified, while three subtypes have been identified in NDM - transient, permanent, and syndromic. Discussion: Despite being estimated to affect approximately 2% of all the T2DM patients in Europe, the exact prevalence of MODY is still unknown, accentuating the need for research focused on biomarkers. Consequently, due to its impact in the course of treatment, follow-up of associated complications, and genetic implications for siblings and offspring of affected individuals, it is imperative to diagnose the monogenic forms of DM accurately. Conclusion: Currently, advances in the genetics field allowed the recognition of new DM subtypes, which until now, were considered slight variations of the typical forms. Thus, it is imperative to act in the close interaction between genetics and clinical manifestations, to facilitate diagnosis and individualize treatment.

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Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder

Video Journal of Sports Medicine ◽

10.1177/26350254211007142 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110071

Author(s):

Ioanna K. Bolia ◽

Rebecca Griffith ◽

Nickolas Fretes ◽

Frank A. Petrigliano

Keyword(s):

Shoulder Instability ◽

Return To Sport ◽

Young Female ◽

Subscapularis Tendon ◽

Shoulder Stabilization ◽

Ehlers Danlos Syndrome ◽

Physically Active ◽

Recurrent Shoulder Instability ◽

Multidirectional Instability

Background: The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI. Indications: Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures. Technique Description: With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o’clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures. Results: Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up. Discussion/Conclusion: Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.

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A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105144 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5144

Author(s):

Mar Muñoz-Chápuli Gutiérrez ◽

Ana Durán-Vila ◽

Javier Ruiz-Labarta ◽

Pilar Payá-Martínez ◽

Pilar Pintado Recarte ◽

...

Keyword(s):

Clinical Manifestations ◽

Specific Treatment ◽

Rt Pcr ◽

Good Adherence ◽

Major Morbidity ◽

Reference Hospital ◽

The Mean ◽

Discharge From Hospital ◽

Over Time

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

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