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Dynamic change of pelvic incidence after long fusion to pelvis with S2-alar-iliac screw: a 2-year follow-up study

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Abstract

Introduction

Pelvic incidence (PI) is a key morphological parameter that reflects the relation between the sacrum and iliac wings. It is well accepted that PI remains constant after reaching maturity. However, recent studies indicated that PI might be altered after lumbosacral fusion. Additionally, it remains uncertain on the long-term influence of long fusion to pelvis with S2-alar-iliac screw on PI in patients with adult spinal deformity (ASD).

Study Design

A retrospective study.

Objective

To investigate whether and how PI would change during the follow-up in ASD patients who underwent S2AI fixation and to identify factors associated with the change in PI.

Methods

We retrospectively reviewed all ASD patients who underwent spinal surgery using S2AI screws between November 2014 and January 2017 at our institution. Patients with minimum follow-up of two years were included. The following sagittal radiographic parameters were measured: PI, Lumbar lordosis (LL), pelvic tilt (PT), PI-LL, sagittal vertical axis (SVA) at pre-op, post-op and 2-year follow-up. According to the changes in PI at immediate post-operation, patients were classified into two groups; Group A: Changes of PI less than or equal 5° and Group B: Changes of PI greater than 5°.

Results

A total of 82 ASD patients (Group A: 32, Group B: 50; mean age of 53.5 ± 12.6 years) with a mean follow-up period of 30.2 ± 9.2 months were included in this study. At immediate post-operation, Group A showed no significant change in PI (45.7° ± 11.4° to 45.3° ± 11.2°, p = 0.749); while Group B had a significant decrease in PI (51.6° ± 14.5° to 40.9° ± 14.0°, p < 0.001). At the last follow-up, 48% patients (24/50) in Group B had a significant increase in PI (32.8° ± 6.4° to 45.8° ± 11.2°, p < 0.001). Intergroup analysis showed that ΔPI, post-op PI, post-op PT and age were significantly different between both groups. In addition, pre-op PI, post-op PI, post-op PT, post-op PI-LL were significantly correlated with ΔPI at last follow-up. Also, logistic regression analysis showed that post-op PI was the associated risk factor (OR = 0.865, p = 0.024) for PI-LL mismatch.

Conclusion

Our study showed that PI decreased in more than half of ASD patients immediately after spinal surgery using S2AI screws. Approximately 48% of them were able to recover during the 2-year follow-up. Lower pre-op PI, post-op PI and PT were found to be strongly associated with the return of PI. Thus, these current findings indicated that patients with a high PI at pre-operation should not be over-corrected to avoid PI-LL mismatch postoperatively.

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Funding

This work was supported by the National Natural Science Foundation of China (NSFC) (No. 82072518), the Nanjing Medical Science and Technique Development Foundation (No. QRX17126) funds, the Jiangsu Provincial Key Medical Center, and the China Postdoctoral Science Foundation (2021M701677).

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Authors and Affiliations

  1. Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

    Zongshan Hu, Chang-Chun Tseng, Jie Li, Yanjie Xu, Zhen Liu, Zezhang Zhu & Yong Qiu

  2. Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China

    Zhikai Qian, Ziyang Tang & Chen Ling

Authors
  1. Zongshan Hu
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  2. Chang-Chun Tseng
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  3. Jie Li
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  4. Zhikai Qian
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  5. Ziyang Tang
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  6. Chen Ling
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  7. Yanjie Xu
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  8. Zhen Liu
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  9. Zezhang Zhu
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  10. Yong Qiu
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Contributions

Zongshan Hu and Chang-Chun Tseng contributed equally to this work.

Corresponding author

Correspondence to Zhen Liu.

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Hu, Z., Tseng, CC., Li, J. et al. Dynamic change of pelvic incidence after long fusion to pelvis with S2-alar-iliac screw: a 2-year follow-up study. Eur Spine J 31, 3566–3572 (2022). https://doi.org/10.1007/s00586-022-07391-9

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  • DOI: https://doi.org/10.1007/s00586-022-07391-9

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