Seil Sohn1,2,3,4, Chun Kee Chung5,6,7, Yongjung Jay Kim8, Chi Heon Kim1,2,3, Sung Bae Park1,9, Hyejin Kim1,2,3. 1. Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea. 2. Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. 3. Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea. 4. Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, South Korea. 5. Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea. chungc@snu.ac.kr. 6. Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. chungc@snu.ac.kr. 7. Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea. chungc@snu.ac.kr. 8. Department of Orthopedics, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 9. Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea.
Abstract
BACKGROUND: A conventional iliac bolt and the S2 alar iliac screw fixation technique (S2AI) are commonly used sacropelvic fixation techniques. However, conventional iliac bolt technique requires a lateral connector and commonly has prominent screw head problems. S2AI reportedly has a high instrument failure rate. We aim to introduce a modified iliac screw fixation technique and to investigate its clinical application in adult patients. METHODS: The entrance site of the modified iliac screw fixation technique was 1 cm medial and 1 cm caudal from the posterosuperior iliac spine. From 2009 to 2015, ten adult patients underwent sacropelvic fixation with the modified iliac screw fixation technique in our spine clinic. A minimum 12-month clinical and radiographic follow-up was adopted. The mean follow-up period was 30.7 months (12-74 months). Mean number of fixation levels was 7.7 segments (5-10 segments). RESULTS: Postoperatively, the C7 plumb line (SVA) was significantly decreased (P = 0.04). Upon the last X-ray, SVA did not differ between postoperative and the last X-ray (P = 0.1). There was no breakage during our follow-up period. There was no prominent screw head. There were no cases requiring implant removal. CONCLUSIONS: The modified iliac screw fixation technique does not cause prominence in the sacral region, and does not require a lateral connector, both of which are necessary when using the classical iliac bolt technique. This technique also avoids the acute angle between the screw head and the shaft of the screw commonly seen in S2AI. The modified iliac screw fixation technique can be an effective alternative for sacropelvic fixation.
BACKGROUND: A conventional iliac bolt and the S2 alar iliac screw fixation technique (S2AI) are commonly used sacropelvic fixation techniques. However, conventional iliac bolt technique requires a lateral connector and commonly has prominent screw head problems. S2AI reportedly has a high instrument failure rate. We aim to introduce a modified iliac screw fixation technique and to investigate its clinical application in adult patients. METHODS: The entrance site of the modified iliac screw fixation technique was 1 cm medial and 1 cm caudal from the posterosuperior iliac spine. From 2009 to 2015, ten adult patients underwent sacropelvic fixation with the modified iliac screw fixation technique in our spine clinic. A minimum 12-month clinical and radiographic follow-up was adopted. The mean follow-up period was 30.7 months (12-74 months). Mean number of fixation levels was 7.7 segments (5-10 segments). RESULTS: Postoperatively, the C7 plumb line (SVA) was significantly decreased (P = 0.04). Upon the last X-ray, SVA did not differ between postoperative and the last X-ray (P = 0.1). There was no breakage during our follow-up period. There was no prominent screw head. There were no cases requiring implant removal. CONCLUSIONS: The modified iliac screw fixation technique does not cause prominence in the sacral region, and does not require a lateral connector, both of which are necessary when using the classical iliac bolt technique. This technique also avoids the acute angle between the screw head and the shaft of the screw commonly seen in S2AI. The modified iliac screw fixation technique can be an effective alternative for sacropelvic fixation.