Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up.
Summary of "Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up."
STUDY DESIGN.: Retrospective review. OBJECTIVE.: Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other methods of screw fixation. SUMMARY OF BACKGROUND DATA.: Iliac anchors have been shown to provide the best form of pelvic fixation. A trajectory from the posterior sacral surface to the iliac wings has recently been described. To our knowledge, no clinical series has compared this method of pelvic fixation in children to others. METHODS.: Of 32 consecutive pediatric patients who underwent SAI fixation, 2 died and 26 returned for follow-up (>2 years). Mean age at surgery was 14 years. Average screw size was 67 mm long and 7 to 9 mm in diameter. Clinical examinations, radiographs, and computed tomography scans were analyzed. Outcomes included pain over the implants, screw placement, implant prominence, radiographic lucency, need for revision, and infection. SAI patients were compared with 27 previous patients who had pelvic fixation via other screw techniques. RESULTS.: For SAI fixation, correction of pelvic obliquity and Cobb angles were 20° ± 11° (70%) and 42° ± 25° (67%), respectively. For other pelvic fixation methods, those values were 10° ± 9° (50%), and 46° ± 16° (60%), respectively. Compared with other screws, SAI screws provided significantly better pelvic obliquity correction (P = 0.002) but no difference in Cobb correction. There were 2 lucencies adjacent to screws in both groups. Computed tomography scans of 18 SAI patients showed no intrapelvic protrusion, but 1 screw extended laterally (<5 mm). One early SAI patient required revision with larger screws, which relieved pain; there was 1 revision in the comparison group. SAI patients had no deep infections, implant prominence, late skin breakdown, or anchor migration; traditional patients had 3 deep infections (P = 0.09) and 3 instances of implant prominence, skin breakdown, or anchor migration. CONCLUSION.: SAI pelvic fixation produces better correction of pelvic obliquity than do previous techniques. Radiographic and clinical anchor stability is satisfactory at 2-year follow-up.
Affiliation
From the *Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; †Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA; and ‡Hospital for Special Surgery, New York, NY.
Journal Details
This article was published in the following journal.
Name: Spine
ISSN: 1528-1159
Pages: 1887-92
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20802390
- DOI: http://dx.doi.org/10.1097/BRS.0b013e3181e03881
Medical and Biotech [MESH] Definitions
Iliac Aneurysm
Abnormal balloon- or sac-like dilatation in the wall of any one of the iliac arteries including the common, the internal, or the external ILIAC ARTERY.
Pelvic Floor
Soft tissue formed mainly by the pelvic diaphragm, which is composed of the two levator ani and two coccygeus muscles. The pelvic diaphragm lies just below the pelvic aperture (outlet) and separates the pelvic cavity from the PERINEUM. It extends between the PUBIC BONE anteriorly and the COCCYX posteriorly.
Lesser Pelvis
The part of the pelvis, inferior to the pelvic brim, that comprises both the pelvic cavity and the part of the PERINEUM lying inferior to the PELVIC DIAPHRAGM.
Lumbosacral Plexus
The lumbar and sacral plexuses taken together. The fibers of the lumbosacral plexus originate in the lumbar and upper sacral spinal cord (L1 to S3) and innervate the lower extremities.
Ilizarov Technique
A bone fixation technique using an external fixator (FIXATORS, EXTERNAL) for lengthening limbs, correcting pseudarthroses and other deformities, and assisting the healing of otherwise hopeless traumatic or pathological fractures and infections, such as chronic osteomyelitis. The method was devised by the Russian orthopedic surgeon Gavriil Abramovich Ilizarov (1921-1992). (From Bull Hosp Jt Dis 1992 Summer;52(1):1)
PubMed Articles
Variations in Sacral Morphology and Implications for Iliosacral Screw Fixation.
Posterior pelvic percutaneous fixation following either closed or open reduction is a popular procedure. Knowledge of the posterior pelvic anatomy, its variations, and related imaging is critical to p...
BACKGROUND: Although both single and dual iliac screw techniques are used in spino-pelvic reconstruction following sacrectomy for treating sacral tumors, the basis for choosing between the two techniq...
Biomechanical comparison of two stabilization techniques for unstable sacral fractures.
AIM: The purpose of the study was to assess the stability provided by an ilio-iliac dorsal plate fixation technique using an AO narrow DCP on the pelvic brim in vertically and rotationally unstable ty...
Natural orifice vaginal sacrocolpopexy (NOVaS): a cadaver feasibility study.
INTRODUCTION AND HYPOTHESIS: The primary objective was to determine the feasibility of a vaginal approach to sacrocolpopexy using a cadaver model. Secondary objectives were to me...
Pelvic fixation for adult scoliosis.
INTRODUCTION: Obtaining a fusion, especially to the sacrum for adult deformity correction remains a challenge. Prior to modern fixation techniques, the reported fusion rates for adult scoliotic deform...
Clinical Trials
Brain Effects of Sacral Neuromodulation
Sacral neuromodulation (SNM) has become an accepted treatment for patients with refractory lower urinary tract dysfunction such as urgency frequency syndrome, urgency incontinence, non-obs...
Mortality associated with pelvic fractures resulting from blunt trauma ranges between 6 and 18%. In cases where hemodynamic instability is also present, the mortality rate is significantl...
One Year Outcome After Robotic Assisted Laparoscopic Sacral Colpopexy, a Case Series Review
Robotic approach to sacral colpopexy is a relatively new procedure. The literature is scarce in regard to its long-term outcomes. This advanced procedure is offered at MMH through the Urog...
The objective of this study is to evaluate the safety and efficacy of the Assurant Cobalt Iliac Stent System in the treatment of de novo and restenotic lesions in iliac arteries of subject...
Zenith(R) Low Profile AAA Endovascular Graft Clinical Study
The Zenith(R) Low Profile AAA Endovascular Graft Clinical Study is a clinical trial approved by US FDA to study the safety and effectiveness of the Zenith(R) Low Profile AAA Endovascular G...
