Gun Keorochana1, Alisara Arirachakaran2, Kittipong Setrkraising3, Jatupon Kongtharvonskul4. 1. Orthopedics Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 2. Orthopedics Department, Bumrungrad International Hospital, Bangkok, Thailand. 3. Orthopedics Department, Police General Hospital, Bangkok, Thailand. 4. Sport and Orthopedic Center, Samitivej Hospital and Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand. Electronic address: Jatupon_kong@hotmail.com.
Abstract
OBJECTIVE: This systematic review and meta-analysis aims to assess and compare the postoperative outcomes of iliac screw (IS) fixation versus sacral 2 alar iliac (S2AI) screw fixation in the adult and pediatric populations. METHODS: We searched all comparative studies that compared postoperative outcomes of IS and S2AI fixation techniques for pelvic fixation from the PubMed and Scopus databases up to June 23, 2019. RESULTS: Eleven of 951 studies (N = 632 patients) were eligible; 8, 10, 5, 6, 3, 7, 2, and 2 studies were included in pooling of postoperative complications, revisions, implant failure, screw breakage, screw prominence, wound dehiscence, wound infection, visual analog scale (VAS), and ambulatory status (AS), respectively. The IS technique had a statistically significant higher chance of postoperative complications, revisions, implant failure, screw breakage, screw prominent, wound dehiscence, and wound infection by 1.89 (95% confidence interval [CI], 1.48-2.40), 1.91 (95% CI, 1.29-2.82), 2.28 (95% CI, 1.55-3.35), 3.96 (95% CI, 1.46-10.75), 6.83 (95% CI, 2.54-18.37), 4.62 (95% CI, 1.32-16.25), and 3.03 (95% CI, 1.62-5.66), respectively compared with the S2AI fixation technique. In subgroup analysis, the IS technique had a statistically significant higher chance of postoperative complications and revisions of 1.65 (95% CI, 1.25-2.16) and 1.71 (95% CI, 1.03-2.84) in pediatric populations and 2.32 (95% CI, 1.60-3.38) and 1.94 (95% CI, 1.00-3.73) in the adult populations compared with the S2AI fixation technique. IS screw fixation had a lower AS of -0.40 (95% CI, -0.76 to -0.15) than did S2AI fixation in the adult and pediatric populations. However, there was no difference in pain VAS between both groups. CONCLUSIONS: Sacropelvic fixation with IS screw fixation had more postoperative complications and revisions and lower AS than did S2AI fixation.
OBJECTIVE: This systematic review and meta-analysis aims to assess and compare the postoperative outcomes of iliac screw (IS) fixation versus sacral 2 alar iliac (S2AI) screw fixation in the adult and pediatric populations. METHODS: We searched all comparative studies that compared postoperative outcomes of IS and S2AI fixation techniques for pelvic fixation from the PubMed and Scopus databases up to June 23, 2019. RESULTS: Eleven of 951 studies (N = 632 patients) were eligible; 8, 10, 5, 6, 3, 7, 2, and 2 studies were included in pooling of postoperative complications, revisions, implant failure, screw breakage, screw prominence, wound dehiscence, wound infection, visual analog scale (VAS), and ambulatory status (AS), respectively. The IS technique had a statistically significant higher chance of postoperative complications, revisions, implant failure, screw breakage, screw prominent, wound dehiscence, and wound infection by 1.89 (95% confidence interval [CI], 1.48-2.40), 1.91 (95% CI, 1.29-2.82), 2.28 (95% CI, 1.55-3.35), 3.96 (95% CI, 1.46-10.75), 6.83 (95% CI, 2.54-18.37), 4.62 (95% CI, 1.32-16.25), and 3.03 (95% CI, 1.62-5.66), respectively compared with the S2AI fixation technique. In subgroup analysis, the IS technique had a statistically significant higher chance of postoperative complications and revisions of 1.65 (95% CI, 1.25-2.16) and 1.71 (95% CI, 1.03-2.84) in pediatric populations and 2.32 (95% CI, 1.60-3.38) and 1.94 (95% CI, 1.00-3.73) in the adult populations compared with the S2AI fixation technique. IS screw fixation had a lower AS of -0.40 (95% CI, -0.76 to -0.15) than did S2AI fixation in the adult and pediatric populations. However, there was no difference in pain VAS between both groups. CONCLUSIONS: Sacropelvic fixation with IS screw fixation had more postoperative complications and revisions and lower AS than did S2AI fixation.
Authors: Daniel Karczewski; Klaus J Schnake; Georg Osterhoff; Ulrich Spiegl; Max J Scheyerer; Bernhard Ullrich; Matthias Pumberger Journal: Global Spine J Date: 2021-06-21