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S2 alar-iliac screws are superior to traditional iliac screws for spinopelvic fixation in adult spinal deformity: a systematic review and meta-analysis

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Abstract

Purpose

Spinopelvic fixation (SPF) using traditional iliac screws has provided biomechanical advantages compared to previous constructs, but common complications include screw prominence and wound complications. The newer S2 alar-iliac (S2AI) screw may provide a lower profile option with lower rates of complications and revisions for adult spinal deformity (ASD). The purpose of this study was to compare rates of complications and revision following SPF between S2AI and traditional iliac screws in patients with ASD.

Methods

A PRISMA-compliant systematic literature review was conducted using Cochrane, Embase, and PubMed. Included studies reported primary data on adult patients undergoing S2AI screw fixation or traditional IS fixation for ASD. Primary outcomes of interest were rates of revision and complications, which included screw failure (fracture and loosening), symptomatic screw prominence, wound complications (dehiscence and infection), and L5-S1 pseudarthrosis.

Results

Fifteen retrospective studies with a total of 1502 patients (iliac screws: 889 [59.2%]; S2AI screws: 613 [40.8%]) were included. Pooled analysis indicated that iliac screws had significantly higher odds of revision (17.1% vs 9.1%, OR = 2.45 [1.25–4.77]), symptomatic screw prominence (9.9% vs 2.2%, OR = 6.26 [2.75–14.27]), and wound complications (20.1% vs 4.4%, OR = 5.94 [1.55–22.79]). S2AI screws also led to a larger preoperative to postoperative decrease in pain (SMD = − 0.26, 95% CI = -0.50, − 0.011).

Conclusion

The findings from this review demonstrate higher rates of revision, symptomatic screw prominence, and wound complications with traditional iliac screws. Current data supports the use of S2AI screws specifically for ASD.

PROSPERO ID

CRD42022336515.

Level of evidence

III.

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Data availability

All data relevant to the study are included in the manuscript and its tables.

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Acknowledgements

The authors thank Holly Pope, Alexander Mebane, and John Pederson of Superior Medical Experts who provided assistance with PROSPERO protocol registration.

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Authors and Affiliations

  1. Mercy Health St. Vincent Medical Center, Toledo, OH, USA

    Roman Rahmani & Thomas Andreshak

  2. HCA Medical City Healthcare UNT-TCU GME (Denton), 3535 S Interstate 35, Denton, TX, 76210, USA

    Samuel D. Stegelmann

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All authors contributed to the study conception and design, have read and approved the final manuscript, and agree to be accountable for the work. RR: Conceptualization, Writing—Review & Editing. SDS: Data Curation; Formal Analysis; Writing—Original Draft, Visualization. TA: Supervision; Validation; Writing—review & editing.

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Correspondence to Samuel D. Stegelmann.

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TA is a lecturer for Medtronic & Surgalign.

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Rahmani, R., Stegelmann, S.D. & Andreshak, T. S2 alar-iliac screws are superior to traditional iliac screws for spinopelvic fixation in adult spinal deformity: a systematic review and meta-analysis. Spine Deform 12, 829–842 (2024). https://doi.org/10.1007/s43390-024-00834-x

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