Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up
Retrospective review. Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other me...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2010-09, Vol.35 (20), p.1887-1892 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
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| creator | SPONSELLER, Paul D ZIMMERMAN, Ryan M KO, Phebe S PULL TER GUNNE, Albert F MOHAMED, Ahmed S CHANG, Tai-Li KEBAISH, Khaled M |
| description | Retrospective review.
Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other methods of screw fixation.
Iliac anchors have been shown to provide the best form of pelvic fixation. A trajectory from the posterior sacral surface to the iliac wings has recently been described. To our knowledge, no clinical series has compared this method of pelvic fixation in children to others.
Of 32 consecutive pediatric patients who underwent SAI fixation, 2 died and 26 returned for follow-up (>2 years). Mean age at surgery was 14 years. Average screw size was 67 mm long and 7 to 9 mm in diameter. Clinical examinations, radiographs, and computed tomography scans were analyzed. Outcomes included pain over the implants, screw placement, implant prominence, radiographic lucency, need for revision, and infection. SAI patients were compared with 27 previous patients who had pelvic fixation via other screw techniques.
For SAI fixation, correction of pelvic obliquity and Cobb angles were 20° ± 11° (70%) and 42° ± 25° (67%), respectively. For other pelvic fixation methods, those values were 10° ± 9° (50%), and 46° ± 16° (60%), respectively. Compared with other screws, SAI screws provided significantly better pelvic obliquity correction (P = 0.002) but no difference in Cobb correction. There were 2 lucencies adjacent to screws in both groups. Computed tomography scans of 18 SAI patients showed no intrapelvic protrusion, but 1 screw extended laterally ( |
| doi_str_mv | 10.1097/BRS.0b013e3181e03881 |
| format | Article |
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Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other methods of screw fixation.
Iliac anchors have been shown to provide the best form of pelvic fixation. A trajectory from the posterior sacral surface to the iliac wings has recently been described. To our knowledge, no clinical series has compared this method of pelvic fixation in children to others.
Of 32 consecutive pediatric patients who underwent SAI fixation, 2 died and 26 returned for follow-up (>2 years). Mean age at surgery was 14 years. Average screw size was 67 mm long and 7 to 9 mm in diameter. Clinical examinations, radiographs, and computed tomography scans were analyzed. Outcomes included pain over the implants, screw placement, implant prominence, radiographic lucency, need for revision, and infection. SAI patients were compared with 27 previous patients who had pelvic fixation via other screw techniques.
For SAI fixation, correction of pelvic obliquity and Cobb angles were 20° ± 11° (70%) and 42° ± 25° (67%), respectively. For other pelvic fixation methods, those values were 10° ± 9° (50%), and 46° ± 16° (60%), respectively. Compared with other screws, SAI screws provided significantly better pelvic obliquity correction (P = 0.002) but no difference in Cobb correction. There were 2 lucencies adjacent to screws in both groups. Computed tomography scans of 18 SAI patients showed no intrapelvic protrusion, but 1 screw extended laterally (<5 mm). One early SAI patient required revision with larger screws, which relieved pain; there was 1 revision in the comparison group. SAI patients had no deep infections, implant prominence, late skin breakdown, or anchor migration; traditional patients had 3 deep infections (P = 0.09) and 3 instances of implant prominence, skin breakdown, or anchor migration.
SAI pelvic fixation produces better correction of pelvic obliquity than do previous techniques. Radiographic and clinical anchor stability is satisfactory at 2-year follow-up.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e3181e03881</identifier><identifier>PMID: 20802390</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Biological and medical sciences ; Bone Screws ; Cerebrospinal fluid. Meninges. Spinal cord ; Child ; Feasibility Studies ; Follow-Up Studies ; Humans ; Ilium - diagnostic imaging ; Ilium - surgery ; Incidence ; Infection - epidemiology ; Internal Fixators ; Medical sciences ; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis ; Nervous system (semeiology, syndromes) ; Neurology ; Orthopedic Procedures - adverse effects ; Orthopedic Procedures - instrumentation ; Orthopedic Procedures - methods ; Pain - epidemiology ; Pelvic Bones - abnormalities ; Pelvic Bones - diagnostic imaging ; Pelvic Bones - surgery ; Radiography ; Retrospective Studies ; Sacrum - diagnostic imaging ; Sacrum - surgery ; Scoliosis - diagnostic imaging ; Scoliosis - surgery ; Surgical Flaps ; Treatment Outcome ; Young Adult</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2010-09, Vol.35 (20), p.1887-1892</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-8c86448fbe51eb682652c78173963df0ec4eab27e6e0c11e510e259988c7031d3</citedby><cites>FETCH-LOGICAL-c365t-8c86448fbe51eb682652c78173963df0ec4eab27e6e0c11e510e259988c7031d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23234898$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20802390$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SPONSELLER, Paul D</creatorcontrib><creatorcontrib>ZIMMERMAN, Ryan M</creatorcontrib><creatorcontrib>KO, Phebe S</creatorcontrib><creatorcontrib>PULL TER GUNNE, Albert F</creatorcontrib><creatorcontrib>MOHAMED, Ahmed S</creatorcontrib><creatorcontrib>CHANG, Tai-Li</creatorcontrib><creatorcontrib>KEBAISH, Khaled M</creatorcontrib><title>Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>Retrospective review.
Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other methods of screw fixation.
Iliac anchors have been shown to provide the best form of pelvic fixation. A trajectory from the posterior sacral surface to the iliac wings has recently been described. To our knowledge, no clinical series has compared this method of pelvic fixation in children to others.
Of 32 consecutive pediatric patients who underwent SAI fixation, 2 died and 26 returned for follow-up (>2 years). Mean age at surgery was 14 years. Average screw size was 67 mm long and 7 to 9 mm in diameter. Clinical examinations, radiographs, and computed tomography scans were analyzed. Outcomes included pain over the implants, screw placement, implant prominence, radiographic lucency, need for revision, and infection. SAI patients were compared with 27 previous patients who had pelvic fixation via other screw techniques.
For SAI fixation, correction of pelvic obliquity and Cobb angles were 20° ± 11° (70%) and 42° ± 25° (67%), respectively. For other pelvic fixation methods, those values were 10° ± 9° (50%), and 46° ± 16° (60%), respectively. Compared with other screws, SAI screws provided significantly better pelvic obliquity correction (P = 0.002) but no difference in Cobb correction. There were 2 lucencies adjacent to screws in both groups. Computed tomography scans of 18 SAI patients showed no intrapelvic protrusion, but 1 screw extended laterally (<5 mm). One early SAI patient required revision with larger screws, which relieved pain; there was 1 revision in the comparison group. SAI patients had no deep infections, implant prominence, late skin breakdown, or anchor migration; traditional patients had 3 deep infections (P = 0.09) and 3 instances of implant prominence, skin breakdown, or anchor migration.
SAI pelvic fixation produces better correction of pelvic obliquity than do previous techniques. Radiographic and clinical anchor stability is satisfactory at 2-year follow-up.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Bone Screws</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Child</subject><subject>Feasibility Studies</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Ilium - diagnostic imaging</subject><subject>Ilium - surgery</subject><subject>Incidence</subject><subject>Infection - epidemiology</subject><subject>Internal Fixators</subject><subject>Medical sciences</subject><subject>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Orthopedic Procedures - adverse effects</subject><subject>Orthopedic Procedures - instrumentation</subject><subject>Orthopedic Procedures - methods</subject><subject>Pain - epidemiology</subject><subject>Pelvic Bones - abnormalities</subject><subject>Pelvic Bones - diagnostic imaging</subject><subject>Pelvic Bones - surgery</subject><subject>Radiography</subject><subject>Retrospective Studies</subject><subject>Sacrum - diagnostic imaging</subject><subject>Sacrum - surgery</subject><subject>Scoliosis - diagnostic imaging</subject><subject>Scoliosis - surgery</subject><subject>Surgical Flaps</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUFvEzEQhS1ERUPhHyDkC-K0xWPveu1jqRoaKahRG4Q4rbzOrGLkXQd7t4HfwJ-uSwJIPc3le29m3iPkDbBzYLr-8PH27py1DAQKUIBMKAXPyAwqrgqASj8nMyYkL3gp5Cl5mdJ3xpgUoF-QU84U40KzGfm9DHu6iqFzHukK_b2zdO5-mtGFgX5145aOW6R3xkbj6YU3kS68M5au0W4H92NC6oY_yAo3zowxy1dhN_mDwaLfxXCPid5imvyYqBnpeh-Kb5iNPrvB9VNP58H7sC-m3Sty0hmf8PVxnpEv86v15XWxvPm0uLxYFlbIaiyUVbIsVddiBdhKxWXFba2gFlqKTcfQlmhaXqNEZgEyxZBXWitlayZgI87I-4NvPi5_kMamd8mi92bAMKWmrirQOVjIZHkgbQwpReyaXXS9ib8aYM1jC01uoXnaQpa9PS6Y2h43_0R_Y8_AuyNgkjW-i2awLv3nBBel0ko8APN6kSI</recordid><startdate>20100915</startdate><enddate>20100915</enddate><creator>SPONSELLER, Paul D</creator><creator>ZIMMERMAN, Ryan M</creator><creator>KO, Phebe S</creator><creator>PULL TER GUNNE, Albert F</creator><creator>MOHAMED, Ahmed S</creator><creator>CHANG, Tai-Li</creator><creator>KEBAISH, Khaled M</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100915</creationdate><title>Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up</title><author>SPONSELLER, Paul D ; ZIMMERMAN, Ryan M ; KO, Phebe S ; PULL TER GUNNE, Albert F ; MOHAMED, Ahmed S ; CHANG, Tai-Li ; KEBAISH, Khaled M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-8c86448fbe51eb682652c78173963df0ec4eab27e6e0c11e510e259988c7031d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Bone Screws</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Child</topic><topic>Feasibility Studies</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Ilium - diagnostic imaging</topic><topic>Ilium - surgery</topic><topic>Incidence</topic><topic>Infection - epidemiology</topic><topic>Internal Fixators</topic><topic>Medical sciences</topic><topic>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Orthopedic Procedures - adverse effects</topic><topic>Orthopedic Procedures - instrumentation</topic><topic>Orthopedic Procedures - methods</topic><topic>Pain - epidemiology</topic><topic>Pelvic Bones - abnormalities</topic><topic>Pelvic Bones - diagnostic imaging</topic><topic>Pelvic Bones - surgery</topic><topic>Radiography</topic><topic>Retrospective Studies</topic><topic>Sacrum - diagnostic imaging</topic><topic>Sacrum - surgery</topic><topic>Scoliosis - diagnostic imaging</topic><topic>Scoliosis - surgery</topic><topic>Surgical Flaps</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SPONSELLER, Paul D</creatorcontrib><creatorcontrib>ZIMMERMAN, Ryan M</creatorcontrib><creatorcontrib>KO, Phebe S</creatorcontrib><creatorcontrib>PULL TER GUNNE, Albert F</creatorcontrib><creatorcontrib>MOHAMED, Ahmed S</creatorcontrib><creatorcontrib>CHANG, Tai-Li</creatorcontrib><creatorcontrib>KEBAISH, Khaled M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SPONSELLER, Paul D</au><au>ZIMMERMAN, Ryan M</au><au>KO, Phebe S</au><au>PULL TER GUNNE, Albert F</au><au>MOHAMED, Ahmed S</au><au>CHANG, Tai-Li</au><au>KEBAISH, Khaled M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2010-09-15</date><risdate>2010</risdate><volume>35</volume><issue>20</issue><spage>1887</spage><epage>1892</epage><pages>1887-1892</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>Retrospective review.
Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other methods of screw fixation.
Iliac anchors have been shown to provide the best form of pelvic fixation. A trajectory from the posterior sacral surface to the iliac wings has recently been described. To our knowledge, no clinical series has compared this method of pelvic fixation in children to others.
Of 32 consecutive pediatric patients who underwent SAI fixation, 2 died and 26 returned for follow-up (>2 years). Mean age at surgery was 14 years. Average screw size was 67 mm long and 7 to 9 mm in diameter. Clinical examinations, radiographs, and computed tomography scans were analyzed. Outcomes included pain over the implants, screw placement, implant prominence, radiographic lucency, need for revision, and infection. SAI patients were compared with 27 previous patients who had pelvic fixation via other screw techniques.
For SAI fixation, correction of pelvic obliquity and Cobb angles were 20° ± 11° (70%) and 42° ± 25° (67%), respectively. For other pelvic fixation methods, those values were 10° ± 9° (50%), and 46° ± 16° (60%), respectively. Compared with other screws, SAI screws provided significantly better pelvic obliquity correction (P = 0.002) but no difference in Cobb correction. There were 2 lucencies adjacent to screws in both groups. Computed tomography scans of 18 SAI patients showed no intrapelvic protrusion, but 1 screw extended laterally (<5 mm). One early SAI patient required revision with larger screws, which relieved pain; there was 1 revision in the comparison group. SAI patients had no deep infections, implant prominence, late skin breakdown, or anchor migration; traditional patients had 3 deep infections (P = 0.09) and 3 instances of implant prominence, skin breakdown, or anchor migration.
SAI pelvic fixation produces better correction of pelvic obliquity than do previous techniques. Radiographic and clinical anchor stability is satisfactory at 2-year follow-up.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>20802390</pmid><doi>10.1097/BRS.0b013e3181e03881</doi><tpages>6</tpages></addata></record> |
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| ispartof | Spine (Philadelphia, Pa. 1976), 2010-09, Vol.35 (20), p.1887-1892 |
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| subjects | Adolescent Biological and medical sciences Bone Screws Cerebrospinal fluid. Meninges. Spinal cord Child Feasibility Studies Follow-Up Studies Humans Ilium - diagnostic imaging Ilium - surgery Incidence Infection - epidemiology Internal Fixators Medical sciences Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Nervous system (semeiology, syndromes) Neurology Orthopedic Procedures - adverse effects Orthopedic Procedures - instrumentation Orthopedic Procedures - methods Pain - epidemiology Pelvic Bones - abnormalities Pelvic Bones - diagnostic imaging Pelvic Bones - surgery Radiography Retrospective Studies Sacrum - diagnostic imaging Sacrum - surgery Scoliosis - diagnostic imaging Scoliosis - surgery Surgical Flaps Treatment Outcome Young Adult |
| title | Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up |
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