Skip to main content
SpringerLink
Log in

Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

Sacropelvic fixation (SPF) is an integral part of ASD surgery. Literature suggests that combination of S1 and iliac screws may be associated with lowest rate of complications.

Aim

To analyze the rate and potential factors of mechanical failure associated with SPF in adult spinal deformity surgery.

Materials and methods

Of 504 patients enrolled in a prospective multicentric database, 239 were treated conservatively and 265 were treated surgically. Forty-five of those who had sacroiliac fixations and with >6 months (or to failure) f/up constitute the population. Type of iliac fixation was S2 alar/iliac (S2AI) screws in 20 (44.4 %) and iliac screws with lateral connectors (IwL) in 25 (55.6 %). Diagnoses were degenerative in 20, failed back in 11 and other in 14. Average instrumentation length was 11.6 ± 4.0 levels. Cases with failure were compared to those without using Fisher’s Exact and Mann–Whitney U tests.

Results

A total of 16 implant related complications were identified (35.6 %). Failures were identified on an average of 224.1 days (8–709) following index surgery. Failure rate of S2AI screws was 35 vs. 12 % for IwL screws (p > 0.05). All broken screws were associated with S2AI technique with polyaxial screws. Comparison of failed cases to others revealed that failed cases had inadequate restoration of Lumbar Lordosis but this was not statistically insignificant. Only age was a significantly different, patient with failure being older.

Discussion

Pelvic fixation is still associated with a very high rate of mechanical failure. Major risk factors appear to be age and type of fixation. Although could not be shown to be statistically significant, failure to restore the optimal sagittal balance may be a contributing factor as well. So in conclusion, in cases with suboptimal sagittal plane correction, S2AI with polyaxial screws seem to have higher risk of short-term acute failure compared to IwL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine 31(20):2329–2336

    Article  PubMed  Google Scholar 

  2. Moshirfar A, Rand FF, Sponseller PD, Parazin SJ, Khanna AJ, Kebaish KM, Stinson JT, Riley LH 3rd (2005) Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am 87(2):89–106

    Article  PubMed  Google Scholar 

  3. Shen FH, Mason JR, Shimer AL, Arlet VM (2013) Pelvic fixation for adult scoliosis. Eur Spine J 22(Suppl 2):S265–S275

    Article  PubMed  Google Scholar 

  4. Devlin VJ, Boachie-Adjei O, Bradford DS, Ogilvie JW, Transfeldt EE (1991) Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation. J Spinal Disord 4(1):1–14

    CAS  PubMed  Google Scholar 

  5. Schwend RM, Sluyters R, Najdzionek J (2003) The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine 28(6):542–547

    PubMed  Google Scholar 

  6. Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, Adjei OB, Wagner TA (2002) Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine 27(21):2312–2320

    Article  PubMed  Google Scholar 

  7. Kebaish KM (2010) Sacropelvic fixation: techniques and complications. Spine 35(25):2245–2251

    Article  PubMed  Google Scholar 

  8. Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C (2006) Minimum 5-year analysis of L5–S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine 31(3):303–308

    Article  PubMed  Google Scholar 

  9. Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG (2001) Minimum two-year analysis of sacropelvic fixation and L5–S1 fusion utilizing S1 and iliac screws. Spine 26(18):1976–1983

    Article  CAS  PubMed  Google Scholar 

  10. Saer EH 3rd, Winter RB, Lonstein JE (1990) Long scoliosis fusion to the sacrum in adults with nonparalytic scoliosis. An improved method. Spine 15(7):650–653

    Article  PubMed  Google Scholar 

  11. Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusion to the sacrum in adult spine deformity: Luque–Galveston, combined iliac and sacral screws, and sacral fixation. Spine 27(7):776–786

    Article  PubMed  Google Scholar 

  12. Pellise F, Domingo-Sabat M, Alanay A, Bago J, VilaCasedemunt A, Villanueva C, Acaroglu E, European Spine Study Group (2012) Impact of radiographic parameters on hrqol in adult spinal deformity- the ‘lordosis gap’ better than lumbar lordosis? Paper # 19 Spineweek. Scientific program abstract book, pp 12

  13. Pateder DB, Park YS, Kebaish KM, Cascio BM, Buchowski JM, Song EW, Shapiro MB, Kostuik JP (2006) Spinal fusion after revision surgery for pseudarthrosis in adult scoliosis. Spine 31(11):E314–E319

    Article  PubMed  Google Scholar 

  14. Allen BL Jr, Ferguson RL (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine 9(4):388–394

    Article  PubMed  Google Scholar 

  15. Cunningham BW, Lewis SJ, Long J, Dmitriev AE, Linville DA, Bridwell KH (2002) Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model. Spine 27(21):2321–2327

    Article  PubMed  Google Scholar 

  16. Kostuik JP (1988) Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum. Orthop Clin North Am 19:371–381

    CAS  PubMed  Google Scholar 

  17. Standard specification and test methods for metallic medical bone screws: ASTM-Designation: F543–13 standarts (www.astm.org)

  18. Yu BS, Li ZM, Zhou ZY, Zeng LW, Wang LB, Zheng ZM, Lu WW (2011) Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw. Clin Biomech (Bristol, Avon) 26(6):556–561

    Article  Google Scholar 

  19. Zheng ZM, Zhang KB, Zhang JF, Yu BS, Liu H, Zhuang XM (2009) The effect of screw length and bone cement augmentation on the fixation strength of iliac screws: a biomechanical study. J Spinal Disord Tech 22(8):545–550

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

This study and the European Spine Study Group are sponsored by a research grant from Depuy Spine Inc.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, Ankara, 06800, Turkey

    Umit Ozgur Guler, Engin Cetin, Onur Yaman & Emre Acaroglu

  2. Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Ferran Pellise, Alba Villa Casademut & Montse Domingo Sabat

  3. Acidadem Maslak Hospital, Istanbul, Turkey

    Ahmet Alanay

  4. Hospital Universitari La Paz, Madrid, Spain

    Francesco Sanchez Perez Grueso

Authors
  1. Umit Ozgur Guler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Engin Cetin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Onur Yaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ferran Pellise
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alba Villa Casademut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Montse Domingo Sabat
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ahmet Alanay
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Sanchez Perez Grueso
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Emre Acaroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

European Spine Study Group

Corresponding author

Correspondence to Emre Acaroglu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guler, U.O., Cetin, E., Yaman, O. et al. Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of mechanical failure. Eur Spine J 24, 1085–1091 (2015). https://doi.org/10.1007/s00586-014-3615-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3615-1

Keywords

Search

Navigation