Safety and accuracy of cannulated versus non-cannulated iliac screws: Cohort study

Year 2020, , 173 - 176, 01.03.2020

Sinan Yılar Serdar Toy , Kemal Zencirli

https://doi.org/10.28982/josam.681468

Abstract

Aim: Fixation with iliac screw is often used in long-segment instrumentation with lumbosacral fusion. Polyaxial screws are sent with fluoroscopy, computerized tomography, and navigation, or by freehand. In our study, we compared the accuracy of the cannulated iliac screw (CAS) and classic iliac screw (CLS) sent under fluoroscopy.
Methods: This study was planned as a cohort study. Patients who underwent long segment fusion and sacroiliac fixation in our clinic between 2015 and 2018 were included in our study. The follow-up period of the patients was at least one year. All radiological and clinical data of patients were followed. Computerized tomographies obtained in the postoperative period were used to investigate the accuracy of the screws. Malposition of the screws was classified as medial, lateral and anterior perforation.
Results: Sixty-six iliac screws of 29 patients who met the study criteria were evaluated. There were 15 patients (34 screws) in the classical screw group and 14 patients (32 screws) in the cannulated screw group. The classic screw group had two screws (one medial, one lateral) malpositioned, while the cannulated screw group had no screw malpositions. There was no statistically significant difference between the two groups. No complications were encountered in both groups during the intraoperative and postoperative periods. While two screws loosening was observed in the CLS group, one screw loosening was observed in the CAS group. No statistically significant difference was found. There was no screw breakage in either group.
Conclusion: The use of cannulated iliac screws for sacroiliac fixation is an effective and reliable treatment option.

Keywords

Bone screw, Joint, Lumbosacral, Sacroiliac

Kanüllü ile kanülsüz iliak vidaların güvenilirliği ve doğru yerleşimi: Kohort çalışma

Abstract

Amaç: İliak vida ile fiksasyon lumbosakral füzyon yapılan uzun segment enstrumanlarda sıklıkla kullanılırlar. Bu işlem için çoğunlukla floroskopi, CT, Navigasyon eşliğinde veya serbest gönderilen poliaksiyel vidalar kullanılır. Biz çalışmamızda floroskopi kontrolü ile gönderilen kanüllü vida (CAV) ve klasik iliak vidanın(CLV) doğruluğunu karşılaştırdık.

Yöntemler: Çalışma, kohort çalışması olarak planlandı. Çalışmamızda 2015-2018 yılları arasında kliniğimizde uzun segment füzyon ve sakroiliak fiksason yapılan hastalar kullanıldı. Hastaların takip süresi en az bir yıl idi. Hastaları takiplerindeki tüm radyolojik ve klinik verileri toplandı. Vidaların doğruluğunu araştırmak için postoperatif dönemde çekilen CT’ler kullanıldı. Vidaların malpozisyonları medial, lateral ve anterior perforasyon olarak sınıflandırıldı. 

Bulgular: Çalışma kriterlerine uyan 29 hastanın 66 iliak vidası değerlendirildi. Klasik vida grubunda 15 hasta (34 vida), kanüllü vida grubunda 14 hasta (32 vida) mevcuttu. Klasik vida grubunda iki vida malpozisyonu mevcutken (bir medial, bir lateral), kanüllü vida grubunda hiç vida malpozisyonu yoktu. İki grup arasında istatistiksel olarak anlamlı fark yoktu. Her iki grupta da cerrahi esnasında ve sonrasında herhangi bir komplikasyonla karşılaşılmadı. CLV grubunda iki vida gevşemesi görülürken CAV grubunda bir vida gevşemesi görüldü. İstatistiksel olarak anlamlı fark bulunamadı. İki grupta da vida kırılması görülmedi. 

Sonuç: Sakroiliak fiksasyon için kanüllü iliak vida kullanımı etkili ve güvenilir bir tedavi seçeneğidir.

Keywords

Kemik vida, Eklem, Lumbosacral, Sakroiliak

References

• 1. Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS. Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine. 2002;27(7):776-86.
• 2. Shen FH, Mason JR, Shimer AL, Arlet VM. Pelvic fixation for adult scoliosis. European Spine Journal. 2013;22(2):265-75.
• 3. Banno T, Ohishi T, Hasegawa T, Yamato Y, Kobayashi S, Togawa D, et al. Accuracy of Iliac Screws Insertion in Adult Spinal Deformity Surgery. Clinical spine surgery. 2017;30(4):407-11.
• 4. DeWald CJ, Stanley TJS. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine. 2006;31(19S):144-51.
• 5. Kebaish KMJS. Sacropelvic fixation: techniques and complications. Spine. 2010;35(25):2245-51.
• 6. Gressot LV, Patel AJ, Hwang SW, Fulkerson DH, Jea A. Iliac screw placement in neuromuscular scoliosis using anatomical landmarks and uniplanar anteroposterior fluoroscopic imaging with postoperative CT confirmation. Journal of Neurosurgery: Pediatrics. 2014;13(1):54-61.
• 7. Wang MY, Ludwig SC, Anderson DG, Mummaneni PV. Percutaneous iliac screw placement: description of a new minimally invasive technique. Neurosurgical Focus. 2008;25(2):17.
• 8. Garrido BJ, Wood KEJTSJ. Navigated placement of iliac bolts: description of a new technique. The Spine Journal. 2011;11(4):331-5.
• 9. Shin JH, DJ Hoh, and IHJON Kalfas. Iliac screw fixation using computer-assisted computer tomographic image guidance. Operative Neurosurgery. 2011;70(suppl_1):16-20.
• 10. Hlubek RJ, Almefty KK, Xu DS, Turner JD, Kakarla UK. Safety and Accuracy of Freehand Versus Navigated Iliac Screws. Spine. 2017;42(20):1190-6.
• 11. Doğan Ö, Çalışkan E, Gencer B, Biçimoğlu A. Effect of loss of correction on functional outcomes in thoracolumbar burst fractures treated with short segment posterior instrumentation. J Surg Med. 2019;3(8):600-4.
• 12. Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Freehand S2 alar-iliac screw placement using k-wire and cannulated screw: technical case series. Journal of Korean Neurosurgical Society. 2018;61(1):75.
• 13. Hu X, Lieberman IHJESJ. Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: feasibility and accuracy. European Spine Journal. 2017;26(3):720-5.
• 14. Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C. Minimum 5-year analysis of L5–S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine. 2006;31(3):303-8.
• 15. Laratta JL, Shillingford JN, Lombardi JM, Alrabaa RG, Benkli B, Fischer C, et al. Accuracy of S2 alar-iliac screw placement under robotic guidance. Spine Deformity. 2018;6(2):130-6.
• 16. Shillingford JN, Laratta JL, Park PJ, Lombardi JM, Tuchman A, Saifi C, et al. Human versus Robot: A Propensity-Matched Analysis of the Accuracy of Free Hand: versus: Robotic Guidance for Placement of S2 Alar-Iliac (S2AI) Screws. Spine. 2018;43(21):1297-304.
• 17. Bederman SS, Hahn P, Colin V, Kiester PD, Bhatia NN. Robotic guidance for S2-alar-iliac screws in spinal deformity correction. Clinical spine surgery. 2017;30(1):49-53.
• 18. Kim BD, Hsu WK, De Oliveira Jr GS, Saha S, Kim JY. Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: an analysis of 4588 surgical cases. Spine. 2014;39(6):510-20.
• 19. Togawa D, Kayanja MM, Reinhardt MK, Shoham M, Balter A, Friedlander A, et al. Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: part 2—evaluation of system accuracy. Operative Neurosurgery. 2007;60(suppl_2):129-39.
• 20. Ughwanogho E, Flynn JJUPOJ. Current navigation modalities in spine surgery. University Pa Orthop J. 2010;20:65-69.
• 21. Putzier M, Strube P, Cecchinato R, Lamartina C, Hoff EK. A new navigational tool for pedicle screw placement in patients with severe scoliosis. Clinical spine surgery. 2017;30(4):430-9.
• 22. Yilar S. Comparison of the accuracy of cannulated pedicle screw versus conventional pedicle screw in the treatment of adolescent idiopathic scoliosis: A randomized retrospective study. Medicine (Baltimore). 2019;98(10):14811.
• 23. Lee CK, Chan CYW, Gani SMA, Kwan MK. Accuracy of cannulated pedicle screw versus conventional pedicle screw for extra-pedicular screw placement in dysplastic pedicles without cancellous channel in adolescent idiopathic scoliosis: a computerized tomography (CT) analysis. European Spine Journal. 2017;26(11):2951-60.
• 24. Shih KS, Hsu CC, Hou SM, Yu SC, Liaw CK. Comparison of the bending performance of solid and cannulated spinal pedicle screws using finite element analyses and biomechanical tests. Medical engineering & physics. 2015;37(9):879-84.