Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up

James H. Nguyen Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by James H. Nguyen in
jns
Google Scholar
PubMed
Close
 MD
,
Thomas J. Buell Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Thomas J. Buell in
jns
Google Scholar
PubMed
Close
 MD
,
Tony R. Wang Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Tony R. Wang in
jns
Google Scholar
PubMed
Close
 MD
,
Jeffrey P. Mullin Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Jeffrey P. Mullin in
jns
Google Scholar
PubMed
Close
 MD
,
Marcus D. Mazur Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Marcus D. Mazur in
jns
Google Scholar
PubMed
Close
 MD
,
Juanita Garces Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Juanita Garces in
jns
Google Scholar
PubMed
Close
 MD
,
Davis G. Taylor Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Davis G. Taylor in
jns
Google Scholar
PubMed
Close
 MD
,
Chun-Po Yen Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Chun-Po Yen in
jns
Google Scholar
PubMed
Close
 MD
,
Christopher I. Shaffrey Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Christopher I. Shaffrey in
jns
Google Scholar
PubMed
Close
 MD
, and
Justin S. Smith Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Search for other papers by Justin S. Smith in
jns
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $384.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $384.00
USD  $624.00
Print or Print + Online Sign in

OBJECTIVE

Recent literature describing complications associated with spinopelvic fixation with iliac screws in adult patients has been limited but has suggested high complication rates. The authors’ objective was to report their experience with iliac screw fixation in a large series of patients with a 2-year minimum follow-up.

METHODS

Of 327 adult patients undergoing spinopelvic fixation with iliac screws at the authors’ institution between 2010 and 2015, 260 met the study inclusion criteria (age ≥ 18 years, first-time iliac screw placement, and 2-year minimum follow-up). Patients with active spinal infection were excluded. All iliac screws were placed via a posterior midline approach using fluoroscopic guidance. Iliac screw heads were deeply recessed into the posterior superior iliac spine. Clinical and radiographic data were obtained and analyzed.

RESULTS

Twenty patients (7.7%) had iliac screw–related complication, which included fracture (12, 4.6%) and/or screw loosening (9, 3.5%). No patients had iliac screw head prominence that required revision surgery or resulted in pain, wound dehiscence, or poor cosmesis. Eleven patients (4.2%) had rod or connector fracture below S1. Overall, 23 patients (8.8%) had L5–S1 pseudarthrosis. Four patients (1.5%) had fracture of the S1 screw. Seven patients (2.7%) had wound dehiscence (unrelated to the iliac screw head) or infection. The rate of reoperation (excluding proximal junctional kyphosis) was 17.7%. On univariate analysis, an iliac screw–related complication rate was significantly associated with revision fusion (70.0% vs 41.2%, p = 0.013), a greater number of instrumented vertebrae (mean 12.6 vs 10.3, p = 0.014), and greater postoperative pelvic tilt (mean 27.7° vs 23.2°, p = 0.04). Lumbosacral junction–related complications were associated with a greater mean number of instrumented vertebrae (12.6 vs 10.3, p = 0.014). Reoperation was associated with a younger mean age at surgery (61.8 vs 65.8 years, p = 0.014), a greater mean number of instrumented vertebrae (12.2 vs 10.2, p = 0.001), and longer clinical and radiological mean follow-up duration (55.8 vs 44.5 months, p < 0.001; 55.8 vs 44.6 months, p < 0.001, respectively). On multivariate analysis, reoperation was associated with longer clinical follow-up (p < 0.001).

CONCLUSIONS

Previous studies on iliac screw fixation have reported very high rates of complications and reoperation (as high as 53.6%). In this large, single-center series of adult patients, iliac screws were an effective method of spinopelvic fixation that had high rates of lumbosacral fusion and far lower complication rates than previously reported. Collectively, these findings argue that iliac screw fixation should remain a favored technique for spinopelvic fixation.

ABBREVIATIONS

ASD = adult spinal deformity; PI-LL = pelvic incidence–lumbar lordosis; PJK = proximal junctional kyphosis; PSIS = posterior superior iliac spine; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; SI = sacroiliac; SVA = sagittal vertical axis; S2AI = S2 alar iliac; VCR = vertebral column resection.
  • Collapse
  • Expand
  • 1

    Cho W, Mason JR, Smith JS, Shimer AL, Wilson AS, Shaffrey CI, et al.: Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine 19:445453, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cunningham BW, Lewis SJ, Long J, Dmitriev AE, Linville DA, Bridwell KH: Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model. Spine (Phila Pa 1976) 27:23212327, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Dayer R, Ouellet JA, Saran N: Pelvic fixation for neuromuscular scoliosis deformity correction. Curr Rev Musculoskelet Med 5:91101, 2012

  • 4

    Elder BD, Ishida W, Lo SL, Holmes C, Goodwin CR, Kosztowski TA, et al.: Use of S2-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine (Phila Pa 1976) 42:E142E149, 2017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Guler UO, Cetin E, Yaman O, Pellise F, Casademut AV, Sabat MD, et al.: Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J 24:10851091, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hoernschemeyer DG, Pashuck TD, Pfeiffer FM: Analysis of the S2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine? Spine J 17:875879, 2017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Ilyas H, Place H, Puryear A: A comparison of early clinical and radiographic complications of iliac screw fixation versus S2 alar iliac (S2AI) fixation in the adult and pediatric populations. J Spinal Disord Tech 28:E199E205, 2015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Ishida W, Elder BD, Holmes C, Goodwin CR, Lo SF, Kosztowski TA, et al.: S2-alar-iliac screws are associated with lower rate of symptomatic screw prominence than iliac screws: radiographic analysis of minimal distance from screw head to skin. World Neurosurg 93:253260, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Ishida W, Elder BD, Holmes C, Lo SL, Goodwin CR, Kosztowski TA, et al.: Comparison between S2-alar-iliac screw fixation and iliac screw fixation in adult deformity surgery: reoperation rates and spinopelvic parameters. Global Spine J 7:672680, 2017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Jain A, Kebaish KM, Sponseller PD: Sacral-alar-iliac fixation in pediatric deformity: radiographic outcomes and complications. Spine Deform 4:225229, 2016

  • 11

    Kasten MD, Rao LA, Priest B: Long-term results of iliac wing fixation below extensive fusions in ambulatory adult patients with spinal disorders. J Spinal Disord Tech 23:e37e42, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Kebaish KM: Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976) 35:22452251, 2010

  • 13

    Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G: Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976) 31:23292336, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, et al.: Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:19761983, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Lafage R, Ferrero E, Henry JK, Challier V, Diebo B, Liabaud B, et al.: Validation of a new computer-assisted tool to measure spino-pelvic parameters. Spine J 15:24932502, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, et al.: Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine (Phila Pa 1976) 27:23122320, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Lee MC, Jarvis C, Solomito MJ, Thomson JD: Comparison of S2-alar and traditional iliac screw pelvic fixation for pediatric neuromuscular deformity. Spine J 18:648654, 2018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Liu G, Hasan MY, Wong HK: The subcrestal iliac-screw: a technical note describing a free hand, in-line, low profile iliac screw insertion technique to avoid side-connector use and reduce implant complications. Spine (Phila Pa 1976) 43:E68E74, 2018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Mattei TA, Fassett DR: Low-profile pelvic fixation with sacral alar-iliac screws. Acta Neurochir (Wien) 155:293297, 2013

  • 20

    Mazur MD, Mahan MA, Shah LM, Dailey AT: Fate of S2-alar-iliac screws after 12-month minimum radiographic follow-up: preliminary results. Neurosurgery 80:6772, 2017

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Mazur MD, Ravindra VM, Schmidt MH, Brodke DS, Lawrence BD, Riva-Cambrin J, et al.: Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine 23:6776, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    OʼShaughnessy BA, Lenke LG, Bridwell KH, Cho W, Zebala LP, Chang MS, et al.: Should symptomatic iliac screws be electively removed in adult spinal deformity patients fused to the sacrum? Spine (Phila Pa 1976) 37:11751181, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Ray WZ, Ravindra VM, Schmidt MH, Dailey AT: Stereotactic navigation with the O-arm for placement of S-2 alar iliac screws in pelvic lumbar fixation. J Neurosurg Spine 18:490495, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Schwend RM, Sluyters R, Najdzionek J: The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976) 28:542547, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Shabtai L, Andras LM, Portman M, Harris LR, Choi PD, Tolo VT, et al.: Sacral alar iliac (SAI) screws fail 75% less frequently than iliac screws in neuromuscular scoliosis. J Pediatr Orthop 37:e470e475, 2017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Shen FH, Mason JR, Shimer AL, Arlet VM: Pelvic fixation for adult scoliosis. Eur Spine J 22 (Suppl 2):S265S275, 2013

  • 27

    Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, et al.: Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 21:9941003, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Sponseller PD, Zimmerman RM, Ko PS, Pull Ter Gunne AF, Mohamed AS, Chang TL, et al.: Low profile pelvic fixation with the sacral alar iliac technique in the pediatric population improves results at two-year minimum follow-up. Spine (Phila Pa 1976) 35:18871892, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    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 (Phila Pa 1976) 31:303308, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2115 304 39
Full Text Views 423 61 6
PDF Downloads 489 69 3
EPUB Downloads 0 0 0