TY - JOUR
T1 - Safety profile of lumbosacropelvic fixation in patients aged 60 years or older
T2 - Comparison between s2-alar-iliac screws and conventional iliac screws
AU - Ishida, Wataru
AU - Ramhmdani, Seba
AU - Casaos, Joshua
AU - Perdomo-Pantoja, Alexander
AU - Elder, Benjamin D.
AU - Theodore, Nicholas
AU - Gokaslan, Ziya L.
AU - Wolinsky, Jean Paul
AU - Sciubba, Daniel M.
AU - Bydon, Ali
AU - Witham, Timothy F.
AU - Lo, Sheng Fu L.
N1 - Funding Information:
J.C. is an HHMI predoctoral research fellow (nonstudy-related). N.T. is a consultant to Globus Medical (nonstudy-related). Z.L.G. receives non-study-related research support from AO Spine North America and honoraria from AO foundation and is a shareholder of Spinal Kinetic as well as US Spine. D.M.S. is a consultant to Medtronic, Depuy-Synthes, Stryker, Nuvasive, K2M, Baxter, and Misonix. J.-P.W. is a consultant to Siemens (nonstudy-related). T.F.W. receives nonstudy-related support from the Gordon and Marilyn Macklin Foundation as well as Eli Lilly and Company. S.-F.L.L. receives nonstudy-related financial support from the AO Foundation and Chordoma Foundation. The remaining authors declare no conflict of interest.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Study Design:This is a retrospective study.Objective:To report the safety profile of S2-alar-iliac (S2AI) in patients over 60, comparing S2AI screws with iliac screws (ISs).Summary of Background Data:The surgical management involving the lumbosacropelvic spine remains a challenge due to high mechanical demand and risk of pseudarthrosis. Previous articles showed lower rates of complications in patients receiving S2AI screws than ISs; however, none of them have focused on patients aged over 60 who may harbor significant comorbidities and thus require more meticulous perioperative management, given these invasive and lengthy procedures.Materials and Methods:Retrospective review of clinical records from 2010 to 2015 identified 60 patients undergoing lumbosacropelvic fixation (17 patients with ISs and 43 patients with S2AI screws) who satisfied the following criteria: (1) patients aged over 60 years old and (2) patients with >1-year follow-up periods. Rates of complications such as unplanned reoperation and cardiorespiratory complications were collected and statistically analyzed.Results:Baseline characteristics such as age, sex, and comorbidities were similar in both groups. The S2AI group had lower rates of reoperation (18.6% vs. 47.4%; P=0.02), surgical site infection (2.3% vs. 29.4%; P=0.006), wound dehiscence (2.3% vs. 29.4%; P=0.006), and postoperative anemia (7.0% vs. 29.4%; P=0.03) and had lower total volume of estimated blood loss (EBL) (mL) (1846.4 vs. 2721.2; P=0.02) and transfused red blood cell units (7.2 vs. 4.7; P=0.04) than the IS group, while rates of L5-S1 pseudarthrosis and other cardiorespiratory complications were similar in both groups. In multivariate analysis, operative time, body mass index, and use of S2AI screws over ISs were independent predictors of EBL.Conclusions:Use of S2AI screws over ISs in patients aged over 60 was associated with lower rates of reoperation, surgical site infection, wound dehiscence, and lower volume of EBL and red blood cell transfusion and is a viable surgical option.
AB - Study Design:This is a retrospective study.Objective:To report the safety profile of S2-alar-iliac (S2AI) in patients over 60, comparing S2AI screws with iliac screws (ISs).Summary of Background Data:The surgical management involving the lumbosacropelvic spine remains a challenge due to high mechanical demand and risk of pseudarthrosis. Previous articles showed lower rates of complications in patients receiving S2AI screws than ISs; however, none of them have focused on patients aged over 60 who may harbor significant comorbidities and thus require more meticulous perioperative management, given these invasive and lengthy procedures.Materials and Methods:Retrospective review of clinical records from 2010 to 2015 identified 60 patients undergoing lumbosacropelvic fixation (17 patients with ISs and 43 patients with S2AI screws) who satisfied the following criteria: (1) patients aged over 60 years old and (2) patients with >1-year follow-up periods. Rates of complications such as unplanned reoperation and cardiorespiratory complications were collected and statistically analyzed.Results:Baseline characteristics such as age, sex, and comorbidities were similar in both groups. The S2AI group had lower rates of reoperation (18.6% vs. 47.4%; P=0.02), surgical site infection (2.3% vs. 29.4%; P=0.006), wound dehiscence (2.3% vs. 29.4%; P=0.006), and postoperative anemia (7.0% vs. 29.4%; P=0.03) and had lower total volume of estimated blood loss (EBL) (mL) (1846.4 vs. 2721.2; P=0.02) and transfused red blood cell units (7.2 vs. 4.7; P=0.04) than the IS group, while rates of L5-S1 pseudarthrosis and other cardiorespiratory complications were similar in both groups. In multivariate analysis, operative time, body mass index, and use of S2AI screws over ISs were independent predictors of EBL.Conclusions:Use of S2AI screws over ISs in patients aged over 60 was associated with lower rates of reoperation, surgical site infection, wound dehiscence, and lower volume of EBL and red blood cell transfusion and is a viable surgical option.
KW - S2-alar-iliac screw
KW - iliac screw
KW - lumbosacropelvic fixation
KW - pelvic screw
KW - reoperation
KW - sacroiliac joint pain
KW - screw prominence
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U2 - 10.1097/BSD.0000000000000806
DO - 10.1097/BSD.0000000000000806
M3 - Article
C2 - 30789493
AN - SCOPUS:85061893308
SN - 2380-0186
VL - 32
SP - E200-E205
JO - Clinical Spine Surgery
JF - Clinical Spine Surgery
IS - 4
ER -