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Shaw KA, Fletcher N, West J, Sachwani N, Romine M, El-Hawary R, Murphy J. Effects of distraction-based distal fixation on pelvic parameter development in early onset scoliosis. Spine Deform 2023; 11:495-500. [PMID: 36223036 DOI: 10.1007/s43390-022-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Prior studies have suggested that distraction-based treatment for early onset scoliosis (EOS) may impede the natural development of the sagittal spinal alignment and pelvic parameters. However, to date no study has investigated the effect of distal fixation on pelvic development. METHODS Ambulatory children with EOS undergoing index distraction-based treatment with distal fixation below T11 were retrospectively reviewed. Patients with distal fixation to the pelvis were identified and compared to children with Spine-based fixation at T12-L5. Radiographic measurements were performed for coronal and sagittal alignment in addition to pelvic parameters (pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) and compared at initial presentation, first erect radiograph, and at 2 years following instrumentation. RESULTS 33 ambulatory children were identified with a minimum of 2-year follow-up (25 female, average 6.59 ± 2.6 years), with 33% (N = 11) instrumented to the pelvis (54.4% female, average 4.42 ± 2.2 years, initial Cobb 76.1°). Children in the pelvis cohort were significantly younger at treatment initiation (P < 0.001). There was no significant difference in PI at the study time periods, however, there was a significant change in PI between presentation and 2-year follow-up with the pelvic fixation demonstrating a mean 12.3° decrease in PI vs a 3.8° increase in the spine-based cohort (P = 0.027). DISCUSSION Distal fixation to the pelvis in ambulatory children with EOS treated with growth-friendly instrumentation was associated with a mean decrease in PI of 12.3° that developed over the 2-year treatment duration. Further research is needed to investigate the long-term implications of these findings on pelvic and spinal development.
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Affiliation(s)
- K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Nicholas Fletcher
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Justin West
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Scottish Rite, Atlanta, GA, USA
| | - Numera Sachwani
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Scottish Rite, Atlanta, GA, USA
| | - Matthew Romine
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Scottish Rite, Atlanta, GA, USA
| | - Ron El-Hawary
- Department of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada
| | - Joshua Murphy
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Scottish Rite, Atlanta, GA, USA.
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Kassab Hassan S, Simon L, Campana M, Julien-Marsollier F, Simon AL, Ilharreborde B. S2-Alar-iliac screw fixation for paediatric neuromuscular scoliosis: Preliminary results after two years. Orthop Traumatol Surg Res 2022; 108:103234. [PMID: 35144011 DOI: 10.1016/j.otsr.2022.103234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Correcting pelvic obliquity is among the main goals of surgery for neuromuscular scoliosis. Spino-pelvic fixation must be stable and capable of withstanding the considerable mechanical forces applied at the lumbo-sacral junction. Selection of the best anchoring option is therefore crucial. S2-alar-iliac (S2AI) screws, which are used in adults, are less often chosen in the French paediatric spinal-surgery community. The objective of this study was to report our preliminary experience with S2AI screws used in the treatment of paediatric patients with neuromuscular scoliosis. HYPOTHESIS Pelvic anchoring by means of S2AI screws is reliable and technically feasible in non-ambulatory children with neuromuscular scoliosis. MATERIALS AND METHODS Consecutive non-ambulatory patients who underwent scoliosis surgery with S2AI screw fixation to the pelvis between 2016 and 2018 were retrospectively included. The surgical procedure consisted in either posterior spinal fusion (PSF) or magnetic growing rod (MGR) implantation. In all patients, radiographs were obtained before surgery, within 3 months after surgery, and at last follow-up; and low-dose computed tomography (CT) was performed before and after surgery. RESULTS We included 25 patients with a mean age of 13.8±4.0 years, 18 managed by PSF and 7 by MGRs. Screw diameters ranged from 7.5 to 9.5mm and all screws were at least 60mm in length. The diameters and lengths were the same on both sides in 16 (89%) patients in the PSF group and in all patients in the MGR group. At last follow-up after a mean of 35.5±3.0 months, pelvic obliquity was corrected in all 23 patients with this abnormality before surgery. Complications consisted of lateral cortical screw breakthrough in 8 (32% of screws) patients and screw malposition in 2 (8% of screws) patients. No clinically significant complications related to the fixation material were recorded. DISCUSSION The results of our study demonstrate the feasibility of S2AI screw fixation in paediatric patients with neuromuscular scoliosis. Pelvic asymmetry and dysmorphism do not contra-indicate the procedure but must be evaluated before surgery. Further work is needed to assess the potential long-term consequences on pain and growth of screw passage through the sacro-iliac joints. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Sammy Kassab Hassan
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Laurie Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Matthieu Campana
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Florence Julien-Marsollier
- Service d'anesthésie - réanimation pédiatrique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France.
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 48 Bd Sérurier, 75019 Paris, France
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Mun F, Vankara A, Suresh KV, Margalit A, Kebaish KM, Sponseller PD. Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up. J Pediatr Orthop 2022; 42:e709-e712. [PMID: 35575763 DOI: 10.1097/bpo.0000000000002187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up. METHODS We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections. RESULTS Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications. CONCLUSIONS SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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Matsumoto H, Fano AN, Ball J, Roye BD, George A, Garg S, Erickson M, Samdani A, Skaggs D, Roye DP, Vitale MG. Uncorrected Pelvic Obliquity Is Associated With Worse Health-related Quality of Life (HRQoL) in Children and Their Caregivers at the End of Surgical Treatment for Early Onset Scoliosis (EOS). J Pediatr Orthop 2022; 42:e390-e396. [PMID: 35142714 DOI: 10.1097/bpo.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND While largely of concern in nonambulatory patients, pelvic obliquity (PO) can be found in many patients with early onset scoliosis (EOS) and may remain following surgery. However, its association with health-related quality of life (HRQoL) in children and their caregivers at the end of treatment is not well understood. The purpose of this study was to investigate the association between residual PO and HRQoL in children and their caregivers at the end of surgical treatment in ambulatory patients with EOS. METHODS In this retrospective cohort study, a multicenter EOS registry was queried to identify ambulatory patients who underwent definitive posterior spinal fusion (PSF) from 2012 to 2019. Patients with fusions extending to the pelvis were excluded. PO was measured at least 1 year following PSF. HRQoL, Parental Burden, Financial Burden, and Satisfaction were assessed through the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) also at a minimum of 1 year following PSF. RESULTS A total of 155 patients (12.5±2.1 y, 73.5% female) were included. Etiology distribution was 30.3% congenital, 12.9% neuromuscular, 21.3% syndromic, and 35.5% idiopathic. In congenital patients, those with residual PO >8 degrees had worse Satisfaction by 23.2 points compared with those with PO ≤8 degrees. In neuromuscular patients, those with residual PO >7 degrees had worse HRQoL by 16.1 points and Parental Burden by 22.3 points compared with their counterparts. In syndromic patients, those with residual PO >8 degrees had worse HRQoL by 14.8 points, Parental Burden by 16.4 points, and Satisfaction by 21.2 points compared with their counterparts. In idiopathic patients, those with >9 degrees of residual PO had worse HRQoL by 15.0 points and Financial Burden by 26.8 points compared with their counterparts. CONCLUSIONS Remaining PO at the end of surgical treatment is associated with worse HRQoL in ambulatory children and their caregivers. These results suggest that correction of PO should remain a primary goal of treatment in patients with EOS undergoing surgery. LEVEL OF EVIDENCE Level II-multicenter retrospective cohort study investigating prognosis.
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Affiliation(s)
- Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | - Adam N Fano
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Jacob Ball
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Ameeka George
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Sumeet Garg
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Mark Erickson
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Amer Samdani
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, PA
| | - David Skaggs
- Department of Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - David P Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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Gao Z, Sun X, Chen C, Teng Z, Xu B, Ma X, Wang Z, Yang Q. Comparative radiological outcomes and complications of sacral-2-alar iliac screw versus iliac screw for sacropelvic fixation. Eur Spine J 2021; 30:2257-70. [PMID: 33987735 DOI: 10.1007/s00586-021-06864-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/13/2020] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the outcomes of sacropelvic fixation (SPF) using sacral-2-alar iliac (S2AI) screw with SPF using iliac screw (IS). METHODS A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus was performed for comparative studies between S2AI and IS for SPF. Two independent investigators selected qualified studies and extracted data indispensably. With 95% confidence intervals (CI), the odds ratio (OR) was applied to dichotomous outcomes and standardized mean difference (SMD) was applied to continuous outcomes for each item. RESULTS We included data from thirteen studies involving 722 patients (S2AI, 357 patients; IS, 365 patients). In the pediatric population, the S2AI group had a smaller pelvic obliquity (PO) than the IS group at final follow-up (SMD, - 0.38; 95% CI, - 0.72 to - 0.04). Patients who underwent S2AI screws showed reduced rates of re-operation (S2AI, 13%; IS, 28%), implant failure (S2AI, 12%; IS, 26%) [screw loosening (S2AI, 8%; IS, 20%); screw breakage (S2AI, 2%; IS, 12%)], implant prominence (S2AI, 2%; IS, 14%), pseudarthrosis (S2AI, 3%; IS, 15%), wound infection (S2AI, 8%; IS, 22%) and less blood loss (S2AI, 2035.4 ml; IS, 2708.4 ml). CONCLUSION Radiological outcomes indicate an effective maintenance of the correction and arrest of progression of deformity by S2AI, which is equal or better than IS. SPF with S2AI screw has obviously lower incidence of postoperative complications and less blood loss. Given these advantages, the S2AI screw seems to be a beneficial alternative to IS.
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Mattei TA. S3 Sacral-Alar Iliac Screw: A Salvage Technique for Pelvic Fixation in Complex Deformity Surgery. World Neurosurg 2020; 139:23-30. [PMID: 32194277 DOI: 10.1016/j.wneu.2020.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/11/2023]
Abstract
Sacral-alar iliac (SAI) screws constitute a relatively new technique for pelvic fixation. Since their initial description in 2007, SAI screws have gained wide popularity among the spine surgery community. In 2013, we first described the possibility of using both S1 and S2 SAI screws for pelvic fixation in revision surgeries for adult degenerative scoliosis. Although a previous radiological study has suggested the feasibility of S3 and S4 SAI screws, to the best of our knowledge, there has been no report in the literature on the clinical use of such techniques. In this brief technical note, we present the first clinical report of the use of S3 SAI screws as a salvage method for pelvic fixation in a patient with suboptimal anatomy that prevented proper placement of S1 and S2 SAI screws. We also discuss the recommended anatomical entry points and trajectory of such screws.
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Affiliation(s)
- Tobias A Mattei
- Division of Neurological Surgery, Saint Louis University, Saint Louis University Hospital, St. Louis, Missouri, USA.
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Keorochana G, Arirachakaran A, Setrkraising K, Kongtharvonskul J. Comparison of Complications and Revisions After Sacral 2 Alar Iliac Screw and Iliac Screw Fixation for Sacropelvic Fixation in Pediatric and Adult Populations: Systematic Review and Meta-Analysis. World Neurosurg 2019; 132:408-420.e1. [DOI: 10.1016/j.wneu.2019.08.104] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/31/2022]
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