After long fusion surgery to correct adult spinal deformity, iliac screw-related complications are common, but have little effect on sagittal alignment deterioration, according to a new study.
Iliac Screw-Related Complications Common but Not Serious
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Secondary#adultspinaldeformity#iliacscrews#longfusionsurgery
The study, “The Incidence of Iliac Screw-Related Complications After Long Fusion Surgery in Patients with Adult Spinal Deformity,” was published in the April 2022 issue of the journal Spine.
“Rigid lumbosacral fixation is crucial to achieve optimal global alignment and successful long-term clinical outcomes,” the researchers wrote. In their study, they wanted “to investigate the long-term clinical outcome and incidence of iliac screw-related complications in patients with adult spinal deformity.”
The retrospective analysis included data of eligible patients with adult spinal deformity who underwent spinopelvic fixation using bilateral iliac screws. They all had at least 5 years of follow-up.
For the study, the researchers defined distal instability as iliac screw loosening and rod breakage between the S1 and iliac screws. Demographic data, health-related quality of life scores, and spinopelvic parameters in the distal instability group were compared to the group without distal instability.
A total of 110 patients were included in the study. The follow-up rate was 69%. Forty-five of the patients had screw loosening and 16 experienced rod breakage. Eight patients needed revision surgery due to iliac screw-related complications.
The researchers reported no significant differences in the Oswestry Disability Index and Scoliosis Research Society questionnaire scores between the distal instability and non-distal instability group.
Overall, the patients with iliac screw loosening had significantly greater values of preoperative pelvic incidence, pelvic tilt, postoperative pelvic tilt, and T1-pelvic angle.
“The incidence rate of iliac screw-related complications was relatively high. However, they had a little effect on sagittal alignment deterioration and there were few cases that required surgery,” the researchers wrote.
Study authors included Tomohiro Banno, M.D., Ph.D., Tomohiko Hasegawa, M.D., Ph.D., Yu Yamato, M.D., Ph.D., Go Yoshida, M.D., Ph.D., Hideyuki Arima, M.D., Ph.D., Shin Oe, M.D., Ph.D., Yuki Mihara, M.D., Ph.D., Koichiro Ide, M.D, Yuh Watanabe, M.D., Kenta Kurosu, M.D., Keiichi Nakai, M.D., Yukihiro Matsuyama, M.D., Ph.D., all of the Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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