When performing long fusions to the sacrum for adult spinal deformity patients, using bilateral S1 screws along could cause loosening or pull out from the screw and L5-S1 cage or graft collapse, according to a study published in Spine.
Surgeons can avoid this complication by adding bilateral iliac screws and an anterior structural cage or graft at L5-S1 to protect S1 screws. However, there still may be L5-S1 rod breakage or dislodgement because of lumbosacral pseudarthrosis, and revision surgery remains challenging.
In the study, researchers examined the radiographic results from 33 patients who were diagnosed and treated for lumbosacral fixation failure. Of the 33 patients, 21 underwent revision surgery. There were 29 patients who received two sacral screws, two patients with one sacral screw and two patients with none.
Screw loosening or pullout at L5 or S1 was reported in 17 of the 19 patients who were treated without distal fixation to the sacral screw. Rod breakage between L5 and S1 occurred only in patients with distal fixation to the sacral screw. At the last follow up, 15 of the 21 revision patients achieved solid fusion while six had additional rod breakage or dislodgement at the lumbosacral junction.
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In the study, researchers examined the radiographic results from 33 patients who were diagnosed and treated for lumbosacral fixation failure. Of the 33 patients, 21 underwent revision surgery. There were 29 patients who received two sacral screws, two patients with one sacral screw and two patients with none.
Screw loosening or pullout at L5 or S1 was reported in 17 of the 19 patients who were treated without distal fixation to the sacral screw. Rod breakage between L5 and S1 occurred only in patients with distal fixation to the sacral screw. At the last follow up, 15 of the 21 revision patients achieved solid fusion while six had additional rod breakage or dislodgement at the lumbosacral junction.
Related Articles on Spine Surgery:
New Study Examines Risk Factors for Complications After Spine Surgery
Study: Electronic Conductivity Device Helpful During Scoliosis Correction
Study Examines Fracture Risk Among Growing Rods