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Sacral-Alar-Iliac Fixation in Pediatric Deformity: Radiographic Outcomes and Complications

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Abstract

Study Design

Retrospective case series.

Objectives

To assess the radiographic outcomes and complications of sacral-alar-iliac (SAI) fixation in children.

Summary of Background Data

Pelvic fixation in children undergoing spinal deformity surgery can be challenging because of complex anatomy, compound biomechanical forces at the lumbosacral junction, and poor bone quality.

Methods

Radiographic and clinical records of 80 consecutive patients aged 18 years or younger who underwent posterior spinal fusion surgery with SAI fixation by one pediatric orthopedic surgeon and who had a minimum 2 years of follow-up (mean follow-up: 3.5 years, range, 2–7 years) were retrospectively reviewed. Changes in coronal curve magnitude and pelvic obliquity were assessed using Student t tests. Significance was set at a p value less than .05 for all analyses.

Results

Pelvic obliquity correction averaged 77%, from 26 ± 13 degrees before surgery to 6 ± 4 degrees at final follow-up (p <.001); 91% of the patients were corrected to a pelvic obliquity of less than 10 degrees. Coronal curve correction averaged 72%, from 78 ± 27 degrees before surgery to 22 ± 15 degrees at final follow-up (p <.001). No patient had vascular or neurologic complications or died perioperatively. Twenty patients (25%) had radiographic evidence of implant-related problems, of which there were nine screw fractures (all in the neck of screws with ≤8-mm outer diameter). Six patients had symptomatic complications associated with SAI fixation (three patients with pseudarthrosis at the lumbosacral junction, all of whom required revision surgery, two patients with implant prominence, and one patient with pain related to implant). Other complications included seven instances of wound dehiscence, three deep wound infections, and one superficial wound infection.

Conclusions

SAI fixation provided a low-profile alternative to iliac screws for the correction of pelvic obliquity. The largest possible diameter screws are recommended, ideally >8 mm.

Level of Evidence

Level 4.

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References

  1. Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery: historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am 2005;87:89–106.

    PubMed  Google Scholar 

  2. Allen Jr BL, Ferguson RL. The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine (Phila Pa 1976) 1984;9:388–94.

    Article  Google Scholar 

  3. Allen Jr BL, Ferguson RLA. 1988 perspective on the Galveston technique of pelvic fixation. Orthop Clin North Am 1988;19:409–18.

    PubMed  Google Scholar 

  4. Ilharreborde B, Hoffmann E, Tavakoli S, et al. Intrasacral rod fixation for pediatric long spinal fusion: results of a prospective study with a minimum 5-year follow-up. J Pediatr Orthop 2009;29:594–601.

    Article  Google Scholar 

  5. Jackson RP, McManus AC. The iliac buttress. A computed tomographic study of sacral anatomy. Spine (Phila Pa 1976) 1993;18:1318–28.

    Article  CAS  Google Scholar 

  6. Kuklo TR, Bridwell KH, Lewis SJ, et al. Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 2001;26:1976–83.

    Article  CAS  Google Scholar 

  7. Tsuchiya K, Bridwell KH, Kuklo TR, et al. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976) 2006;31:303–8.

    Article  Google Scholar 

  8. Peelle MW, Lenke LG, Bridwell KH, et al. Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: Galveston rod versus iliac and lumbosacral screws. Spine (Phila Pa 1976) 2006;31:2392–8.

    Article  Google Scholar 

  9. O’Shaughnessy BA, Lenke LG, Bridwell KH, et al. Should symptomatic iliac screws be electively removed in adult spinal deformity patients fused to the sacrum? Spine (Phila Pa 1976) 2012;37:1175–81.

    Article  Google Scholar 

  10. Sponseller PD. The S2 portal to the ilium. Roundtables Spine Surg 2007;2:83–7.

    Google Scholar 

  11. O’Brien JR, Matteini L, Yu WD, et al. Feasibility of minimally invasive sacropelvic fixation: percutaneous S2 alar iliac fixation. Spine (Phila Pa 1976) 2010;35:460–4.

    Article  Google Scholar 

  12. O’Brien JR, Yu WD, Bhatnagar R, et al. An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976) 2009;34:E439–42.

    Article  Google Scholar 

  13. Chang TL, Sponseller PD, Kebaish KM, et al. Low profile pelvic fixation. Anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976) 2009;34:436–40.

    Article  Google Scholar 

  14. Sponseller PD, Zimmerman RM, Ko PS, 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) 2010;35:1887–92.

    Article  Google Scholar 

  15. Aleissa S, Parsons D, Grant J, et al. Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors. Can J Surg 2011;54:263–9.

    Article  Google Scholar 

  16. Cahill PJ, Warnick DE, Lee MJ, et al. Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine (Phila Pa 1976) 2010;35:1211–7.

    Article  Google Scholar 

  17. Sponseller PD, Jain A, Shah SA, et al. Deep wound infections after spinal fusion in children with cerebral palsy: a prospective cohort study. Spine (Phila Pa 1976) 2013;38:2023–7.

    Article  Google Scholar 

  18. Sponseller PD, LaPorte DM, Hungerford MW, et al. Deep wound infections after neuromuscular scoliosis surgery. A multicenter study of risk factors and treatment outcomes. Spine (Phila Pa 1976) 2000;25:2461–6.

    Article  CAS  Google Scholar 

  19. Gitelman A, Joseph Jr SA, Carrion W, et al. Results and morbidity in a consecutive series of patients undergoing spinal fusion with iliac screws for neuromuscular scoliosis. Orthopedics 2008;31:1198.

    Article  Google Scholar 

  20. Myung KS, Lee C, Skaggs DL. Early pelvic fixation failure in neuromuscular scoliosis. J Pediatr Orthop 2015;35:258–65.

    PubMed  Google Scholar 

  21. Phillips JH, Gutheil JP, Knapp Jr DR. Iliac screw fixation in neuromuscular scoliosis. Spine (Phila Pa 1976) 2007;32:1566–70.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA

    Amit Jain MD, Khaled M. Kebaish MD & Paul D. Sponseller MD, MBA

Authors
  1. Amit Jain MD
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  2. Khaled M. Kebaish MD
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  3. Paul D. Sponseller MD, MBA
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Corresponding author

Correspondence to Paul D. Sponseller MD, MBA.

Additional information

The authors thank Rohan Joshi, MD, for assistance in data gathering.

Author disclosures

AJ (none); KMK (royalties from DePuy Synthes; consulting fees from Orthofix, DePuy Synthes, and K2M; institutional grants from DePuy Synthes); PDS (consultancy fees from DePuy Synthes Spine, Globus; institutional grants from Setting Scoliosis Straight Foundation; royalties from Globus).

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Jain, A., Kebaish, K.M. & Sponseller, P.D. Sacral-Alar-Iliac Fixation in Pediatric Deformity: Radiographic Outcomes and Complications. Spine Deform 4, 225–229 (2016). https://doi.org/10.1016/j.jspd.2015.11.005

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  • DOI: https://doi.org/10.1016/j.jspd.2015.11.005

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