Sacropelvic fixation with iliosacral screws: applications and results in adult spinal deformities.

STUDY

DESIGN

Retrospective radiographic and clinical review.

OBJECTIVE

To determine the feasibility of iliosacral screw fixation in adult spinal deformations.

SUMMARY OF BACKGROUND DATA: Pelvic fixation is one of the most challenging instrumentation problems. The poor bone quality frequently found within the sacrum and the large lumbosacral loads with cantilever pullout forces across this region explain its frequent failure.

METHODS

Fourteen adult patients undergoing pelvic fixation using iliosacral screws with a minimal follow-up of 24 months were analyzed for radiographic outcomes. Radiographic data included the localization of the spinal deformity, the Cobb angle, T4-T12 thoracic kyphosis, L1-S1 lumbar lordosis, the T9 tilt, the pelvic parameters, and the POA. Mechanical and infectious complications were also noted.

RESULTS

The lumbo-pelvic correction was performed with a large reduction of the POA in every case. The frontal and sagittal corrections obtained with this procedure were considered as being effective. There were no mechanical complications due to failure of the instrumentation, loss of sacral fixation, or loss of lumbar lordosis at the time of the last follow-up. One patient experienced local infection on the left iliosacral screw without any residual functional sequel.

DISCUSSION: Iliosacral screwing can offer a pelvic fixation reliable enough to allow restoration of 3-dimensional trunk balance. This technique has a quite short learning curve and adequately permits frontal and sagittal corrections, increases stability, and decreases instrumentation-related complications. Our observations suggest that it is applicable to pelvic fixation in adult surgery.