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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Instrumentation of the lumbosacral spine by the sacral-alar-iliac technique can reduce screw loosening whilst improving gluteal pain

Instrumentierung der lumbosakralen Wirbelsäule mittels Sakral-Alar-Ilium-Technik reduziert Schraubenlockerung bei Verbesserung von glutealem Schmerz

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  • Nico Sollmann - Klinikum rechts der Isar München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Sebastian Ille - Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Bernhard Meyer - Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • presenting/speaker Sandro Krieg - Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV045

doi: 10.3205/20dgnc049, urn:nbn:de:0183-20dgnc0493

Published: June 26, 2020

© 2020 Sollmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Instrumentation of the lumbosacral spine continues to be a challenging area in spine surgery, which is particularly due to complex local anatomy, unique biochemical force distributions, and comparatively poor sacral bone quality. Concepts for construct improvement are therefore welcomed. This study aims to investigate differences in outcome between patients treated with S2-alar-iliac (S2AI), S2-alar (S2A), and iliac (I) instrumentation as the most caudal level.

Methods: Sixty patients underwent stabilization by one of the three techniques between 01/2012 and 06/2017 (S2AI: 18 patients, 50% females, 72.1 ± 7.4 years; S2A: 20 patients, 35% females, 69.8 ± 8.6 years; I: 22 patients, 41% females, 69.5 ± 9.0 years). Outcome (screw loosening and gluteal pain due to sacroiliac joint [SIJ] pain) was compared between the three groups considering preoperative, 3-months follow-up (FU), and maximum FU examinations. Bone mineral density (BMD) was opportunistically assessed in preoperative imaging by computed tomography (CT).

Results: All patients completed 3-months FU, maximum FU time was 2.3 ± 0.9 (S2AI), 3.0 ± 1.7 (S2A), and 2.4 ± 1.6 (I) years (p = 0.38). A median of 5 segments (S2AI, S2A) and 3 segments (I) were operated on (p = 0.26), extending to S2 or the os ilium, respectively. BMD did not significantly differ between the groups (p = 0.66), cages were more frequently implanted in patients of the S2A group (p = 0.04). Screw loosening of sacral or iliac screws was more common in patients of the S2A and I when compared to the S2AI group (S2AI: 16.7%, S2A: 55.0%, I: 27.3% of patients; p = 0.03). Furthermore, SIJ pain was more often improved in the S2AI group for 3-months FU, but also for maximum FU (S2AI: 61.1%, S2A: 25.0%, I: 22.7% of patients showing improvement; p = 0.020).

Conclusion: Instrumentation by S2AI might be considered superior to S2A and I stabilizations by showing lower incidences of screw loosening of the most caudal level and enhanced alleviation of SIJ pain. Future studies enrolling larger series are necessary to confirm these initial results.