Rates of Loosening, Failure, and Revision of Iliac Fixation... : Spine

2022-07-16 01:54:29 By : Ms. EASTOPS D.F.S

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Eastlack, Robert K. MDa,b; Soroceanu, Alex MDc; Mundis, Gregory M. Jr MDa,b; Daniels, Alan H. MDd; Smith, Justin S. MD, PhDe; Line, Breton BSMEf,g,h; Passias, Peter MDi,j; Nunley, Pierce D. MDk; Okonkwo, David O. MD, PhDl; Than, Khoi D. MDm; Uribe, Juan MDn; Mummaneni, Praveen V. MD, MBAo,p; Chou, Dean MDp; Shaffrey, Christopher I. MDq; Bess, Shay MDf,g,h;  the International Spine Study Group

aDepartment of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA

bSan Diego Spine Foundation, San Diego, CA

cDepartment of Orthopaedic Surgery – Spine, University of Calgary, Calgary, Canada

eDepartment of Neurosurgery, University of Virginia, Charlottesville, VA

fDenver International Spine Center, Denver, CO

gRocky Mountain Hospital for Children, Denver, CO

hPresbyterian/St. Luke’s Medical Center, Denver, CO

iNew York Spine Institute, New York, NY

jNYU Medical Center/NYU School of Medicine, New York, NY

kSpine Institute of Louisiana, Shreveport, LA

lDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA

mDepartment of Neurosurgery and Orthopaedic Surgery, Duke University, Raleigh, NC

nDepartment of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ

oSpine Center, University of California, San Francisco, CA

pDepartment of Neurological Surgery, University of California, San Francisco, CA

The manuscript submitted does not contain information about medical device(s)/drug(s).

Financial Support: Grant support from SI Bone and supported by the ISSG.

IRB/Research Ethics Committee Statement: Institutional Review Board approval was obtained at all institutions participating in the study.

Conflicts of Interest and Source of Funding: All authors report the following disclosures:

Robert K. Eastlack, MD: Stock Ownership – SeaSpine, Alphatec, Spine Innovation Nuvasive, SI Bone; Royalties – Aesculap, SeaSpine, SI Bone, Globus Nuvasive Medical; Consultant – NuVasive, Medtronic, SeaSpine, Spinal Elements, SI Bone, Biedermann Motech, Stryker Carevature, ControlRad.

Gregory M. Mundis, Jr., MD: Royalties – NuVasive, Stryker; Consultant – NuVasive, SeaSpine, Viseon, Carlsmed.

Alan Daniels, MD: Consultant – Spineart, Orthofix, Medicrea/Medtronic, EOS, Southern Spine.

Justin S. Smith, MD, PhD: Consultant – Zimmer Biomet, NuVasive, DePuy Synthes, Carlsmed, Cerapedics, Stryker, and SeaSpine; Royalties – Zimmer Biomet, NuVasive, Thieme; Research Funding – DePuy Synthes/ISSGF, NuVasive, AOSpine; Fellowship Funding – AOSpine; Editorial Boards – Journal of Neurosurgery Spine, Neurosurgery, Operative Neurosurgery, Spine Deformity, and Neurospine.

Breton Line, BSME: Consultant – ISSG.

Peter Passias, MD: Design Team Cervical – Globus; Scientific Board – Royal Biologics; Consultant – Medtronic, Terumo.

David O. Okonkwo, MD: Royalties and Consulting Fees – Zimmer Biomet, NuVasive.

Khoi D. Than, MD: Consultant – Bioventus, DePuy Synthes, Integrity Implants; Honoraria – LifeNet Health, Globus.

Juan Uribe, MD: Consultant – Viseon, Misonix, SI Bone, and NuVasive. Royalties, stock/stock options, and non-study related research support – NuVasive. Royalties – SI Bone.

Praveen Mummaneni, MD, MBA: Consultant – DePuy Spine, Globus, Stryker;Royalties – DePuy Spine, Thieme Publishing, Springer Publishing; Stocks – Spinicity/ISD;Grants/Funding Sources – AO Spine (Spine Fellowship Grant), ISSG (MIS Deformity), NREF (QOD), PCORI (CSM-S Trial), Alan and Jacqueline Stuart Spine Outcomes Center (SLIP-II), Joan O’Reilly Endowed Professorship, NIH/NIAMS U19AR076737 (UCSF REACH).

Dean Chou, MD: Consultant – Globus, Orthofix; Royalties – Globus.

Shay Bess, MD – Funding Sources – ISSGF, SI Bone, NuVasive, K2 Stryker, DePuy Synthes.

International Spine Study Group: Funding – DePuy Synthes Spine, K2M, NuVasive, Allosource, Biomet, and Orthofix.

Address correspondence and reprint requests to Robert K. Eastlack, MD, Department of Orthopaedic Surgery, Scripps Clinic, 10710 N Torrey Pines Road, La Jolla, CA 92037; E-mail: [email protected] ; [email protected]

Retrospective cohort review of a prospective multicenter database.

Identify rates and variations in lumbopelvic fixation failure after adult spinal deformity (ASD) correction.

Traditional iliac (IS) and S2-alar-iliac (S2AI) pelvic fixation methods have unique technical characteristics for their application, and result in varied bio-mechanical and anatomic impact. These differences may lead to variance in lumbopelvic fixation failure types/rates.

ASD patients undergoing correction with more than five level fusion and pelvic fixation, separated by pelvic fixation type (IS vs. S2AI). Fixation fracture or loosening assessed radiographically (Figure 1). Multivariate logistic regression, accounting for significant confounders, was used to examine differences between the two groups for screw loosening/fracture, rod fracture, and revision surgery. Level of significance set at P< 0.05.

Four hundred eighteen of 1422 patients were included (IS = 287, S2AI = 131). The groups had similar age, body mass index (BMI), baseline comorbidities, number of levels fused (P>0.05), baseline health related quality of life measures (HRQLs) (short form survey-36, Oswestry Disability Index [ODI], Scoliosis Research Society [SRS-22], numeric rating scale [NRS] leg and back, P>0.05) and deformity (pelvic tilt [PT], pelvic incidence-lumbar lordosis [PI-LL], and sagittal vertical axis [SVA], P> 0.05). The IS group had more unilateral fixation versus S2AI (12.9% vs. 6%; P = 0.02). The overall lumbopelvic fixation failure rate was 23.74%. Pelvic fixation (13.4%) and S1 screw (2.9%) loosening was more likely with S2AI (odds ratio [OR] 2.63, P = 0.001; OR 6.05, P = 0.022). Pelvic screw (2.3%) and rod fracture (14.1%) rates similar between groups but trended toward less occurrence with S2AI (OR 0.47, P= 0.06). Revision surgery occurred in 22.7%, and in 8.5% for iliac fixation specifically, but with no differences between fixation types (P = 0.55 and P = 0.365). Pelvic fixation failure conferred worse HRQL scores (physical component score [PCS] 36.23 vs. 39.37, P= 0.04; ODI 33.81 vs. 27.93, P = 0.036), and less 2 years improvement (PCS 7.69 vs. 10.46, P = 0.028; SRS 0.83 vs. 1.03, P = 0.019; ODI 12.91 vs. 19.77, P = 0.0016).

Lumbopelvic fixation failure rates were high following ASD correction, and associated with lesser clinical improvements. S2AI screws were more likely to demonstrate loosening, but less commonly associated with rod fractures at the lumbopelvic region.

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Keywords adult deformity , fixation loosening , fracture fixation , iliac fixation , iliac screws , pelvic fixation , S2 alar iliac screws , sacroiliac joint

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