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Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery.

Publication ,  Journal Article
Eastlack, RK; Soroceanu, A; Mundis, GM; Daniels, AH; Smith, JS; Line, B; Passias, P; Nunley, PD; Okonkwo, DO; Than, KD; Uribe, J; Chou, D ...
Published in: Spine (Phila Pa 1976)
July 15, 2022

STUDY DESIGN: Retrospective cohort review of a prospective multicenter database. OBJECTIVE: Identify rates and variations in lumbopelvic fixation failure after adult spinal deformity (ASD) correction. SUMMARY OF BACKGROUND DATA: Traditional iliac (IS) and S2-alar-iliac (S2AI) pelvic fixation methods have unique technical characteristics for their application, and result in varied bio-mechanical and anatomic impact. These differences may lead to variance in lumbopelvic fixation failure types/rates. METHODS: ASD patients undergoing correction with more than five level fusion and pelvic fixation, separated by pelvic fixation type (IS vs. S2AI). Fixation fracture or loosening assessed radiographically (Figure 1). Multivariate logistic regression, accounting for significant confounders, was used to examine differences between the two groups for screw loosening/fracture, rod fracture, and revision surgery. Level of significance set at P< 0.05. RESULTS: Four hundred eighteen of 1422 patients were included (IS = 287, S2AI = 131). The groups had similar age, body mass index (BMI), baseline comorbidities, number of levels fused (P>0.05), baseline health related quality of life measures (HRQLs) (short form survey-36, Oswestry Disability Index [ODI], Scoliosis Research Society [SRS-22], numeric rating scale [NRS] leg and back, P>0.05) and deformity (pelvic tilt [PT], pelvic incidence-lumbar lordosis [PI-LL], and sagittal vertical axis [SVA], P> 0.05). The IS group had more unilateral fixation versus S2AI (12.9% vs. 6%; P = 0.02). The overall lumbopelvic fixation failure rate was 23.74%. Pelvic fixation (13.4%) and S1 screw (2.9%) loosening was more likely with S2AI (odds ratio [OR] 2.63, P = 0.001; OR 6.05, P = 0.022). Pelvic screw (2.3%) and rod fracture (14.1%) rates similar between groups but trended toward less occurrence with S2AI (OR 0.47, P= 0.06). Revision surgery occurred in 22.7%, and in 8.5% for iliac fixation specifically, but with no differences between fixation types (P = 0.55 and P = 0.365). Pelvic fixation failure conferred worse HRQL scores (physical component score [PCS] 36.23 vs. 39.37, P= 0.04; ODI 33.81 vs. 27.93, P = 0.036), and less 2 years improvement (PCS 7.69 vs. 10.46, P = 0.028; SRS 0.83 vs. 1.03, P = 0.019; ODI 12.91 vs. 19.77, P = 0.0016). CONCLUSION: Lumbopelvic fixation failure rates were high following ASD correction, and associated with lesser clinical improvements. S2AI screws were more likely to demonstrate loosening, but less commonly associated with rod fractures at the lumbopelvic region.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

July 15, 2022

Volume

47

Issue

14

Start / End Page

986 / 994

Location

United States

Related Subject Headings

  • Spinal Fusion
  • Retrospective Studies
  • Quality of Life
  • Prospective Studies
  • Orthopedics
  • Ilium
  • Humans
  • Adult
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
 

Citation

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Eastlack, R. K., Soroceanu, A., Mundis, G. M., Daniels, A. H., Smith, J. S., Line, B., … International Spine Study Group, . (2022). Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery. Spine (Phila Pa 1976), 47(14), 986–994. https://doi.org/10.1097/BRS.0000000000004356
Eastlack, Robert K., Alex Soroceanu, Gregory M. Mundis, Alan H. Daniels, Justin S. Smith, Breton Line, Peter Passias, et al. “Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery.Spine (Phila Pa 1976) 47, no. 14 (July 15, 2022): 986–94. https://doi.org/10.1097/BRS.0000000000004356.
Eastlack RK, Soroceanu A, Mundis GM, Daniels AH, Smith JS, Line B, et al. Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery. Spine (Phila Pa 1976). 2022 Jul 15;47(14):986–94.
Eastlack, Robert K., et al. “Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery.Spine (Phila Pa 1976), vol. 47, no. 14, July 2022, pp. 986–94. Pubmed, doi:10.1097/BRS.0000000000004356.
Eastlack RK, Soroceanu A, Mundis GM, Daniels AH, Smith JS, Line B, Passias P, Nunley PD, Okonkwo DO, Than KD, Uribe J, Mummaneni PV, Chou D, Shaffrey CI, Bess S, International Spine Study Group. Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery. Spine (Phila Pa 1976). 2022 Jul 15;47(14):986–994.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

July 15, 2022

Volume

47

Issue

14

Start / End Page

986 / 994

Location

United States

Related Subject Headings

  • Spinal Fusion
  • Retrospective Studies
  • Quality of Life
  • Prospective Studies
  • Orthopedics
  • Ilium
  • Humans
  • Adult
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences