Different distal fixation anchors in lumbosacral spinal deformities associated with sacral agenesis: which one is better?

Tianyuan Zhang PhD, Hongda Bao MD, Shibin Shu PhD, Zhen Liu MD, Xu Sun MD, Bin Wang MD, Yong Qiu MD, and Zezhang Zhu MD
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  • Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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OBJECTIVE

Sacral agenesis (SA) is a rare congenital malformation of the spine. There has been a paucity of clinical research to investigate the surgical outcome of spinopelvic fixation in these patients. In this study, the authors aimed to evaluate the outcome of different distal fixation anchors in lumbosacral spinal deformities associated with SA and to determine the optimal distal fixation anchor.

METHODS

Patients with diagnoses of SA and lumbosacral scoliosis undergoing spinopelvic fixation with S1 screws, iliac screws, or S2-alar-iliac (S2AI) screws were analyzed. The main curve, coronal balance distance, and pelvic obliquity were compared at baseline, postoperatively, and during follow-up in three groups. The complications were also recorded.

RESULTS

A total of 24 patients were included: 8 patients were stratified into group 1 (S1 screws), 9 into group 2 (iliac screws), and 7 into group 3 (S2AI screws). The main curves were well corrected postoperatively (p < 0.05) in all groups. Coronal balance showed a tendency of deterioration during follow-up in patients with S1 screws (from 18.8 mm to 27.0 mm). Regarding pelvic obliquity, patients with both iliac and S2AI screws showed significant correction (from 3.7° to 2.3° and from 3.3° to 1.6°). Implant-related complications were rod breakage in 3 patients and infection in 1 patient in group 2, and no implant-related complications were observed in group 3. There were 3 cases of unilateral S1 pedicle screw misplacement in group 1.

CONCLUSIONS

Spinopelvic fixation is a safe and effective procedure that can achieve coronal correction in lumbosacral scoliosis associated with SA. Compared with S1 and iliac screws, S2AI screws as distal fixation anchors can achieve a more satisfactory correction with fewer implant-related complications.

ABBREVIATIONS CBD = coronal balance distance; POA = pelvic obliquity angle; SA = sacral agenesis; S2AI = S2-alar-iliac.

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Contributor Notes

Correspondence Zezhang Zhu: Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. zhuzezhang@126.com.

INCLUDE WHEN CITING Published online March 26, 2021; DOI: 10.3171/2020.9.SPINE201390.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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