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Safety Profile of Lumbosacropelvic Fixation in Patients Aged 60 Years or Older

Comparison Between S2-Alar-Iliac Screws and Conventional Iliac Screws

Ishida, Wataru MD*; Ramhmdani, Seba MD*; Casaos, Joshua BS*; Perdomo-Pantoja, Alexander MD*; Elder, Benjamin D. MD, PhD; Theodore, Nicholas MD*; Gokaslan, Ziya L. MD; Wolinsky, Jean-Paul MD§; Sciubba, Daniel M. MD*; Bydon, Ali MD*; Witham, Timothy F. MD*; Lo, Sheng-Fu L. MD*

doi: 10.1097/BSD.0000000000000806

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.

*Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD

Department of Neurosurgery, Mayo Clinic, Rochester, MN

Department of Neurosurgery, Brown University School of Medicine, Providence, RI

§Department of Neurological Surgery, Northwestern University, Chicago, IL

W.I. and S.R. contributed equally.

J.C. is an HHMI predoctoral research fellow (nonstudy-related). N.T. is a consultant to Globus Medical (nonstudy-related). Z.L.G. receives nonstudy-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.

Reprints: Sheng-Fu L. Lo, MD, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 5-109, Baltimore, MD 21287 (e-mail:

Received February 23, 2018

Accepted January 8, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.