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

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

Öz

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.

Anahtar Kelimeler

• Kemik vida,Eklem,Lumbosacral,Sakroiliak

Kaynakça

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