Iliac Screw Fixation Revisited: Improved Clinical and Radiologic Outcomes Using a Modified Iliac Screw Fixation Technique. Issue 1 (February 2022)

• Record Type: Journal Article
• Authors: von Glinski, Alexander; Elia, Christopher J.; Wiginton, James G.; Ansari, Darius; Pierre, Clifford; Ishak, Basem; Yilmaz, Emre; Blecher, Ronen; Dettori, Joseph R.; Hayman, Erik; Schildhauer, Thomas A.; Oskouian, Rod J.; Chapman, Jens R.
• Is Part Of: Clinical spine surgery. Volume 35:Issue 1(2022)
• Publication Date: 2022-02
• Subjects: modified iliac screw fixation -- S2 alar-iliac screw fixation -- lumbopelvic fixation; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000001182
• Languages: English
• ISSNs: 2380-0186

Abstract

Abstract : Study Design: A retrospective study. Objective: To describe the modified iliac screw (mILS) technique and compare it to other spinopelvic fixation techniques in terms of wound healing complications, hardware prominence, and failure. Summary of Background Data: The traditional entry point of an iliac screw often causes postoperative gluteal pain from the prominent screw head. The use of an offset connector also adds a point of weakness to the construct. By choosing a different screw entry point offset connectors can be avoided, and the screw head itself is less prominent, thereby reducing postoperative discomfort. Materials and Methods: A retrospective analysis was performed of adult patients undergoing lumbopelvic fixation (LPF) between January 2014 and June 2019. Patients were grouped into 1 of 3 groups based on the technique of pelvic fixation: S2 alar-iliac (S2AI) screw, traditional iliac screw (tILS), and mILS. The primary outcome parameter was the minimal distance from screw head to skin. Secondary outcome parameters were instrumentation loosening/failure, adjacent level fractures, pseudoarthrosis, and medial or lateral iliac screw perforation. Results: A total of 190 patients undergoing LPF were included in the following 3 groups: mILS group (n=113), tILS group (n=40), and S2AI group (n=37). The mean minimal distance from screw head to skin in the mILS group was 31.3 mm compared with 23.7 mm in the tILS group ( P <0.00199). No statistically significant differences were found when comparing the 3 groups with respect to complications. The mILS group did not show any cases of prominent instrumentation and had the lowest rate of instrumentation failure. Conclusions: The mILS technique is an acceptable alternative for LPF, offering the benefits of iliac screw fixation while avoiding offset connectors and screw prominence complications associated with tILS. Level of Evidence: Level III.