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Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis

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Abstract

Introduction

Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF.

Aims/objectives

Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery.

Materials/methods

The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18 years of age, minimum 1-year follow-up, and cohort or case–control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12 months follow-up with radiographic assessment.

Results

Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6 years). The mean SPFF rate was 22.1% (range 3–41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group.

Conclusion

The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA

    Kari Odland & David W. Polly Jr.

  2. Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA

    Hani Chanbour & Scott L. Zuckerman

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  1. Kari Odland
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  2. Hani Chanbour
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  4. David W. Polly Jr.
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Contributions

KO & DP contributed to study conception and design. Material preparation, data collection, and analysis were performed by KO, & HC. KO, DP, HC, & SZ commented on the previous versions of the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Kari Odland.

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Conflict of interest

KO and HC declare no financial conflicts. DP has consultancies with SI-Bone, Globus, and Alexion, royalties SI-Bone and Springer (textbook), research support from Medtronic and MizuhoOSI and Medtronic. SLZ is a member of the NFL Head, Neck, and Spine Injury Committee and an Unaffiliated Neurotrauma Consultant for the NFL.

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Research protocol for this project, which relied on de-identified data, did not require University of Minnesota Institutional Review Board approval.

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Odland, K., Chanbour, H., Zuckerman, S.L. et al. Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08241-6

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  • DOI: https://doi.org/10.1007/s00586-024-08241-6

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