Durability and Failure Types of S2-Alar-Iliac Screws: An Analysis of 312 Consecutive Screws

2020 ◽  
Vol 20 (1) ◽  
pp. 91-97
Author(s):  
Seung-Jae Hyun ◽  
Jong-myung Jung ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng
Keyword(s):  
Clinical Outcomes ◽  
Screw Fixation ◽  
Patient Characteristics ◽  
Shaft Fracture ◽  
Consecutive Series ◽  
Computed Tomographic ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Failure Types

Abstract BACKGROUND S2-alar-iliac (S2AI) screws improve stability across the lumbosacral junction in spinopelvic fixation procedures by crossing the cortical surfaces of the sacroiliac joint (SIJ), thereby increasing the biomechanical strength of the instrumentation. OBJECTIVE To investigate the durability and failure types of S2AI screws after spinopelvic reconstruction surgery. METHODS A single-center, single-surgeon consecutive series of patients who underwent spinopelvic fixation using bilateral S2AI screws with a ≥1-yr follow-up and at least 1 postoperative computed tomographic scan were retrospectively reviewed. Patient characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. RESULTS In total, 312 S2AI screws in 156 patients were evaluated (mean follow-up, 26.1 mo; range 12-71 mo). There were no significant differences in screw diameter, length, or insertion angle between right-side and left-side screws. Visual analogue scale scores for back pain, ambulatory status, and Oswestry Disability Index scores significantly improved. A total of 10 patients (3.2%) experienced SIJ pain after S2AI screw installation. SIJ pain improved in 8 of them following SIJ block. In total, 7 screws (2.2%) showed partial periscrew lucency. Set screw dislodgement occurred in 7 screws (2.2%). Screw fracture occurred in 6 screws (1.9%): 5 neck fractures and 1 shaft fracture. A total of 5 patients (1.6%) underwent revision surgery for S2AI screw failure. Distal device (L4-pelvis region) breakage occurred in 5 patients. CONCLUSION The radiographic and clinical outcomes of S2AI screw fixation were acceptable. However, S2AI screw fixation has several drawbacks, including screw fracture and dislodgement of the set screw. SIJ irritation symptoms after S2AI screw fixation occurred with considerable frequency.

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

2019 ◽  
Vol 30 (5) ◽  
pp. 635-643 ◽  
Author(s):  
James H. Nguyen ◽  
Thomas J. Buell ◽  
Tony R. Wang ◽  
Jeffrey P. Mullin ◽  
Marcus D. Mazur ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Wound Dehiscence ◽  
Adult Patients ◽  
Complication Rates ◽  
Related Complication ◽  
Screw Head ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw

OBJECTIVERecent 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.METHODSOf 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.RESULTSTwenty 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).CONCLUSIONSPrevious 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.

scholarly journals Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

2014 ◽  
Vol 36 (5) ◽  
pp. E10 ◽  
Author(s):  
Rajiv Saigal ◽  
Darryl Lau ◽  
Rishi Wadhwa ◽  
Hai Le ◽  
Morsi Khashan ◽  
...  
Keyword(s):  
Postoperative Infection ◽  
Screw Fixation ◽  
Insufficiency Fractures ◽  
Single Institution ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw ◽  
Sacral Insufficiency Fractures ◽  
The Mean

Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

scholarly journals A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

2016 ◽  
Vol 40 (6) ◽  
pp. E7 ◽  
Author(s):  
Syed F. Abbas ◽  
Morgan P. Spurgas ◽  
Benjamin S. Szewczyk ◽  
Benjamin Yim ◽  
Ashar Ata ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Neck Disability Index ◽  
Case Series ◽  
Patient Characteristics ◽  
Short Term ◽  
Instrumented Fusion ◽  
Minimally Invasive Surgical ◽  
Neck Disability

OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive surgical approach that appears to result in similar clinical outcomes when compared with a well-accepted strategy of ventral decompression and instrumented fusion. The current results suggest that future comparative effectiveness studies are warranted as the miPCD technique avoids instrumented fusion.

Effect of mannitol on globe and orbital volumes in humans

2018 ◽  
Vol 28 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Adam C. Weber ◽  
Alexander D. Blandford ◽  
Bryan R. Costin ◽  
Julian D. Perry
Keyword(s):  
Volume Change ◽  
Cleveland Clinic ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Orbital Volume ◽  
Computed Tomographic ◽  
Before And After ◽  
Pressure Lowering ◽  
Volume Measurements

Purpose: To determine the effect of intravenous mannitol on globe and orbital volumes. Methods: Retrospective chart review of a consecutive series of Cleveland Clinic Neurosurgical Intensive Care Unit patients who underwent computed tomographic imaging before and after intravenous mannitol administration. Volume measurements were performed according to a previously described technique by averaging axial image areas. Measurements before and after mannitol administration were compared using paired t-test. Results: Fourteen patients (28 eyes) met inclusion criteria. Average globe volume decreased 186 mm3 (-2.5%, p = 0.02) after mannitol administration, while average orbital volume increased 353 mm3 (+3.5%, p = 0.04). Average globe volume change for subjects with follow-up scan less than 4.7 hours (mean 1.9 hours; range 0.2-4.5 hours) after mannitol administration was -125 mm3 (-1.7%, p = 0.24) and average orbital volume change was +458 mm3 (+5.1%, p = 0.11). Average globe volume change after mannitol administration for those with follow-up more than 4.7 hours (average 13.9 hours, range 4.9-24.7 hours) was -246 mm3 (-3.3%, p = 0.05) and orbital volume change was +248 mm3 (+2.2%, p = 0.24). Dividing the study population into groups based on mannitol dose did not yield any statistically significant change. Conclusions: Human globe volume decreases after intravenous mannitol administration, while orbital volume increases. These volume changes occur during the time period when intraocular pressure normalizes, after the pressure-lowering effects of the drug. This novel volumetric information improves our understanding of mannitol’s mechanism of action and its effects on human ocular and periocular tissues.

scholarly journals Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

2017 ◽  
Vol 06 (04) ◽  
pp. 294-300 ◽  
Author(s):  
Avanthi Mandaleson ◽  
Michael Wagels ◽  
Stephen Tham
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Pinch Grip ◽  
The Mean ◽  
Therapeutic Study

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.

TRANSLAMINAR VERSUS PEDICLE SCREW FIXATION OF C2: COMPARISON OF SURGICAL MORBIDITY AND ACCURACY OF 313 CONSECUTIVE SCREWS

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons343-ons349 ◽  
Author(s):  
Scott L. Parker ◽  
Matthew J. McGirt ◽  
Giannina L. Garcés-Ambrossi ◽  
Vivek A. Mehta ◽  
Daniel M. Sciubba ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Patient Characteristics ◽  
Pedicle Screw Fixation ◽  
Cervical Fusion ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Computed Tomographic ◽  
Operative Revision ◽  
C2 Laminar Screw

Abstract OBJECTIVE C2 translaminar (TL) screws rigidly capture the posterior elements of C2, avoid risk of vertebral artery injury, and are less technically demanding than C2 pedicle (PD) screws. However, a C2-TL screw breach places the spinal cord at risk, and the durability of C2-TL screws remains unknown. It is unclear if TL versus PD screw fixation of C2 is truly associated with less operative morbidity, greater accuracy of screw placement, or equivalent durability. METHODS We retrospectively reviewed the records of 167 consecutive patients undergoing posterior cervical fusion with either PD or TL screw fixation of C2. Perioperative morbidity, breach of the C2 lamina or pedicle on postoperative computed tomographic scans, and rates of operative revision were compared between PD and TL screw constructs in axial (C1–C2 or C1–C3) and subaxial (C2 and caudal) cervical fusions. RESULTS In total, 152 C2-TL screws and 161 C2-PD screws were placed in 167 patients. Thirty-one (19%) cases of axial cervical fusion (C1–C2 or C1–C3) were performed (mean age, 63.8 ± 20.6 years) with either C2-TL (16 [52%]) or C2-PD (15 [48%]) screw fixation. One hundred thirty-six (81%) cases of subaxial cervical fusion (C2-caudal) were performed (mean age, 57.9 ± 14.7 years) with either C2-TL (66 [49%]) or C2-PD (70 [51%]) screw fixation. For both axial and subaxial cervical fusions, baseline patient characteristics and all measures of perioperative morbidity were similar between C2-TL and C2-PD screw cohorts. In total, 11 (7%) PD screws breached the pedicle (0 requiring acute revision) versus only 2 (1.3%) TL screws that breached the C2 lamina (1 requiring acute revision) (P = 0.018). By 1 year postoperatively, pseudoarthrosis or screw pullout requiring reoperation was required in 4 (6.1%) patients with C2-TL screws versus 0 (0%) patients with PD screws (P &lt; 0.05 for subaxial constructs). No cases of C2-TL or C2-PD axial fusion required reoperation or screw pullout or pseudoarthrosis. CONCLUSION In our experience, radiographic breach of C2 pedicle screws occurred more frequently than C2 laminar screw breach. However, this was not associated with an increase in morbidity. By 12 months postoperatively, C2-TL screws were associated with a greater incidence of operative revision when used in subaxial constructs but similarly effective for axial cervical constructs. The 1-year durability of C2-TL screws might be inferior to C2 pedicle screws for subaxial fusions, but equally effective for axial cervical fusions.

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

2019 ◽  
Vol 33 (05) ◽  
pp. 513-524 ◽  
Author(s):  
Corey Scholes ◽  
Milad Ebrahimi ◽  
Nalan Ektas ◽  
John Ireland
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Second Generation ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Rotating Platform ◽  
Patient Reported ◽  
Total Knee

AbstractThere is a lack of clinical outcomes reported for the rotating bearing knee (RBK) total knee arthroplasty (TKA), which is a second-generation rotating platform knee, with purported benefits over earlier versions. The purpose of the study was to report the complications, short-term (minimum 1 year) patient-reported outcomes and long-term (up to 15 years) procedure survival in a consecutive series of patients receiving a rotating platform TKA (RBK) from an independent clinic. A retrospective analysis of a single-surgeon, private/public practice, with prospectively collected data in a subset of patients were performed. A total of 1,130 procedures (primary, revision from unicompartmental knee arthroplasty (UKA) to TKA) were crossmatched with manufacturer records. Clinical outcomes (complications, reoperations) were summarized and linked to patient-reported outcome measures (Eq. 5D, KSS-function, Oxford knee score [OKS]). OKS results were classified using minimally clinical important difference (MCID) and patient acceptable symptom state (PASS). PROMs were summarized and regression models used to determine relationships between patient factors and outcomes in this cohort. Cumulative percent revision was reported by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and compared between the senior author and national data using Kaplan–Meier survival analysis. We report a complication rate of 19.7% with the majority (> 60%) being thromboembolic events and complaints of stiffness. Significant improvements were observed in general health, knee pain, and function with > 89% exceeding the MCID for the OKS and > 65% exceeding the PASS for the OKS at an average follow-up of 3.2 years. We report a cumulative revision rate of 4.3% at 5 years and 4.8% at 14 years, with significantly lower revision rates in females and patients aged 55 to 64 years compared with AOANJRR data for fixed bearing designs. The RBK rotating platform TKA provides good functional outcomes, with relatively low revision and complications rates at up to 14 years follow-up. This design in conjunction with a gap balancing technique may be advantageous in certain patient subgroups.

LONG-SEGMENT SPINAL FIXATION USING PELVIC SCREWS

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A183-A190 ◽  
Author(s):  
Luis M. Tumialán ◽  
Praveen V. Mummaneni
Keyword(s):  
Screw Fixation ◽  
X Rays ◽  
Pelvic Fixation ◽  
Computed Tomographic ◽  
Structural Support ◽  
Radiographic Outcomes ◽  
Flexion Extension ◽  
Fixation Techniques ◽  
Sacral Tumors

ABSTRACT OBJECTIVE Long spinal constructs that extend to the sacrum place added stress on sacral screws. To prevent premature loosening of sacral fixation in these cases, the addition of pelvic screw (iliac screw) fixation has gained in popularity. Pelvic screw fixation has also been used in cases where sacral screw fixation is not possible (e.g., in sacral tumors). Pelvic screw fixation is more straightforward than prior pelvic rod fixation techniques (e.g., the Galveston technique). We describe our technique for pelvic screw fixation and review our experience with this technique. METHODS Twenty consecutive patients who underwent spinal-pelvic fixation were followed over a 3-year period (2004–2007). The patient population consisted of 11 men and 9 women with an average age of 58.8 years. Indications for spinal-pelvic fixation in this series included kyphoscoliosis, lumbosacral pseudoarthrosis, sacral fractures, lumbosacral spondylolisthesis, sacral tumors, and lumbar osteomyelitic fractures. Radiographic outcomes were assessed using flexion-extension x-rays and computed tomographic scans. Clinical outcomes were assessed using Odom's criteria and modified Prolo scale. RESULTS One patient was lost to radiographic follow-up. One patient died after surgery. The mean follow-up for the remaining patients was 13 months (range, 1–21 mo). Odom's outcomes were rated as good to excellent in 11 (58%), fair in 7 (37%), and poor in 1 (5%) (one patient died). Preoperative and postoperative modified Prolo scores were 10.4 and 12.9, respectively (mean improvement, 2.5). Radiographic fusion across the lumbosacral junction was obtained in 16 (89%) of the 18 patients with follow-up. One patient required revision of a pelvic screw. There was one infection requiring explantation of hardware. CONCLUSION Pelvic screw fixation is a safe and effective technique that provides added structural support to S1 screws in long-segment spinal fusions. Furthermore, pelvic screw fixation provides a distal point of fixation in cases where sacral screw fixation is not possible. The use of polyaxial screws and connectors makes this technique easier than Galveston rod fixation of the pelvis.

scholarly journals Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 650
Author(s):  
Kyra Hermans ◽  
Duncan Fransz ◽  
Lisette Walbeehm-Hol ◽  
Paul Hustinx ◽  
Heleen Staal
Keyword(s):  
Primary Outcome ◽  
Patient Characteristics ◽  
Shaft Fracture ◽  
Trauma Mechanism ◽  
Isolated Fracture ◽  
The Face ◽  
Biomechanical Effect ◽  
Full Force ◽  
Radiographic Classification

A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association between a parry fracture and the probability of abuse in children. In this retrospective, observational, multicenter study, we identified patients between 2 and 16 years old who had been treated for an isolated ulnar shaft fracture. Patient characteristics were registered, anonymized radiographs were rated, and charts were screened for referral to a child protective team. A total of 36 patients were analyzed. As no referrals were registered during follow-up, the primary outcome was changed to a perpendicular force as trauma mechanism. Univariable regression analysis and independent t-test both showed no significant association between patient factors or radiographic classification, and the reported trauma mechanism. We were unable to determine an association between a parry fracture and the probability of abuse. Since trauma mechanism does have a biomechanical effect on the fracture type, we would advise that a very clear reconstruction (and documentation) of the trauma mechanism should be established when a parry fracture is identified on radiographs.

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

2021 ◽  
pp. 1-6
Author(s):  
Tianyuan Zhang ◽  
Hongda Bao ◽  
Shibin Shu ◽  
Zhen Liu ◽  
Xu Sun ◽  
...  
Keyword(s):  
Pelvic Obliquity ◽  
Spinal Deformities ◽  
Coronal Balance ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Group 3 ◽  
Group 2 ◽  
Distal Fixation ◽  
Group 1

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.

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