Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?

Background Data: Posterior spinal fusion has been more and more used for management of degenerative disorders of the lumbosacral spine. Long-segment fixation of three or more motion segments extending down to the sacrum has been associated with loosening or failure of S1 screws. Purpose: Comparison...

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Autores principales:	Shamel Elgawhary, MD., Mohammed Khalid Saleh, MD., Sherif Alagamy, MD.
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2020
Materias:	sacropelvic fixation pedicle screw loosening long-segment fixation lumbar spine Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/01f4b5a2f8ba4da0ae96cda001e6fcaa
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spelling	oai:doaj.org-article:01f4b5a2f8ba4da0ae96cda001e6fcaa2021-12-02T10:01:57ZCan Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?10.21608/ESJ.2020.21646.11192314-89502314-8969https://doaj.org/article/01f4b5a2f8ba4da0ae96cda001e6fcaa2020-01-01T00:00:00Zhttps://www.esj.journals.ekb.eg/article_93883_9feaa3056879c2a8383b9b68ee2956b0.pdfhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Posterior spinal fusion has been more and more used for management of degenerative disorders of the lumbosacral spine. Long-segment fixation of three or more motion segments extending down to the sacrum has been associated with loosening or failure of S1 screws. Purpose: Comparison between fixations extending to S1 and those to S2 (S2-alar-iliac screws) with sacropelvic fixation in the management of multilevel lumbar spinal canal stenosis. Study Design: Prospective controlled cohort study. Patients and Methods: We recruited 45 patients suffering from lumbar spinal canal stenosis of 3 or more levels including 16 revision cases in the whole group. In 23 patients, posterior lumbar fusion extended to S1 and in 22 fixations extended to S2. Pre- and postoperative clinical evaluation included Visual Analogue Scale (VAS) for back pain and Oswestry Disability Index (ODI). Preoperative radiological evaluation included plain X-ray and MRI. Postoperative clinical evaluation included VAS and ODI and radiological evaluation included X-ray and CT. The mean follow-up duration was 14.1±1.7 months (range, 12–24) in S1 group and 14.3±1.9 months (range, 12–24) in S2 group. Results: The mean VAS improved from 8.1±0.8 to 4.9±0.9 in S1 group and from 7.7±1.2 to 1.95±0.79 in S2 group. The mean ODI improved from 77±10.5 and 76.8±10.9 to 45.9±7.3 and 29.5±8.4 in S1 and S2 groups, respectively. Two dural tears were repaired intraoperatively with no postoperative consequences. Seven cases in S1 group had loosening of S1 screw that was evident at 6-month follow-up. Conclusion: Sacropelvic fixation in the form of S2-alar-iliac screws provides a significantly more rigid construct, decreasing the incidence of loosening of S1 screws and improving the overall outcome in patients treated with long lumbar fusion. (2019ESJ199) Shamel Elgawhary, MD.Mohammed Khalid Saleh, MD.Sherif Alagamy, MD.Egyptian Spine Associationarticlesacropelvic fixationpedicle screw looseninglong-segment fixationlumbar spineNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 33, Iss 1, Pp 36-44 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	sacropelvic fixation pedicle screw loosening long-segment fixation lumbar spine Neurology. Diseases of the nervous system RC346-429
spellingShingle	sacropelvic fixation pedicle screw loosening long-segment fixation lumbar spine Neurology. Diseases of the nervous system RC346-429 Shamel Elgawhary, MD. Mohammed Khalid Saleh, MD. Sherif Alagamy, MD. Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?
description	Background Data: Posterior spinal fusion has been more and more used for management of degenerative disorders of the lumbosacral spine. Long-segment fixation of three or more motion segments extending down to the sacrum has been associated with loosening or failure of S1 screws. Purpose: Comparison between fixations extending to S1 and those to S2 (S2-alar-iliac screws) with sacropelvic fixation in the management of multilevel lumbar spinal canal stenosis. Study Design: Prospective controlled cohort study. Patients and Methods: We recruited 45 patients suffering from lumbar spinal canal stenosis of 3 or more levels including 16 revision cases in the whole group. In 23 patients, posterior lumbar fusion extended to S1 and in 22 fixations extended to S2. Pre- and postoperative clinical evaluation included Visual Analogue Scale (VAS) for back pain and Oswestry Disability Index (ODI). Preoperative radiological evaluation included plain X-ray and MRI. Postoperative clinical evaluation included VAS and ODI and radiological evaluation included X-ray and CT. The mean follow-up duration was 14.1±1.7 months (range, 12–24) in S1 group and 14.3±1.9 months (range, 12–24) in S2 group. Results: The mean VAS improved from 8.1±0.8 to 4.9±0.9 in S1 group and from 7.7±1.2 to 1.95±0.79 in S2 group. The mean ODI improved from 77±10.5 and 76.8±10.9 to 45.9±7.3 and 29.5±8.4 in S1 and S2 groups, respectively. Two dural tears were repaired intraoperatively with no postoperative consequences. Seven cases in S1 group had loosening of S1 screw that was evident at 6-month follow-up. Conclusion: Sacropelvic fixation in the form of S2-alar-iliac screws provides a significantly more rigid construct, decreasing the incidence of loosening of S1 screws and improving the overall outcome in patients treated with long lumbar fusion. (2019ESJ199)
format	article
author	Shamel Elgawhary, MD. Mohammed Khalid Saleh, MD. Sherif Alagamy, MD.
author_facet	Shamel Elgawhary, MD. Mohammed Khalid Saleh, MD. Sherif Alagamy, MD.
author_sort	Shamel Elgawhary, MD.
title	Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?
title_short	Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?
title_full	Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?
title_fullStr	Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?
title_full_unstemmed	Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?
title_sort	can sacropelvic fixation improve outcome of long-segment lumbar spine fusion in patients with degenerative lumbar spine disease?
publisher	Egyptian Spine Association
publishDate	2020
url	https://doaj.org/article/01f4b5a2f8ba4da0ae96cda001e6fcaa
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Can Sacropelvic Fixation Improve Outcome of Long-Segment Lumbar Spine Fusion in Patients with Degenerative Lumbar Spine Disease?

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