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Triple Pelvic Ring Fixation in Patients With Severe Pregnancy-Related Low Back and Pelvic Pain

van Zwienen, C. Marieke A. , MD*†; van den Bosch, Eric W., MD*; Snijders, Chris J., PhD; van Vugt, Arie B., MD, PhD*

doi: 10.1097/01.BRS.0000092367.25951.4A
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Study Design.  Single-group prospective follow-up study.

Objectives.  To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed.

Background data.  More than half of all pregnant women experience PLBP. In most cases, the pain disappears after childbirth. In some, however, the pain becomes chronic and patients may be wheelchair-bound or bedridden. After failure of all conservative treatment, surgical fixation of the pelvic ring seems to be the only remaining option for those severe cases.

Materials and Methods.  The postsurgical functional outcome of 58 severe PLBP patients was evaluated with the Majeed score and endurance of walking, sitting, and standing. Inclusion criteria were serious disability and failure of all conservative treatment. The surgical technique consisted of a symphysiodesis and bilateral percutaneous placement of two sacroiliac screws under fluoroscopic guidance.

Results.  With a follow-up of an average of 2.1 years, the difference between preoperative and postoperative Majeed score indicated that an improvement of more than 10 points was achieved in 69.8% and 89.3% of the patients at 12 and 24 months, respectively. The most important complications were irritation of nerve roots (8.6%), nonunion of the symphysis (15.5%), failure of the symphyseal plate (3.4%), and pulmonary embolism (1.7%).

Conclusions.  In this preliminary study, surgical fixation of the pelvic ring yielded satisfactory results in severe PLBP patients in terms of pain relief and improvement in ADL functions. These results should be confirmed in a randomized clinical trial.

After failure of all conservative treatment, surgical fixation of the pelvic ring by symphysiodesis and bilateral sacroiliac screws was performed in 58 patients severely disabled by pregnancy-related low back and pelvic pain (PLBP). Preliminary results showed an improvement of complaints in about 70% of severe PLBP patients 12 months postoperatively.

From *University Hospital Rotterdam, Department of Traumatology and

†Erasmus University, Rotterdam, Biomedical Physics and Technology.

Acknowledgment date: July 22, 2002.

First revision date: November 27, 2002.

Second revision date: March 31, 2003.

Acceptance date: April 7, 2003.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Address correspondence and reprint requests to Dr. A.B. van Vugt, University Hospital Rotterdam, Department of Traumatology, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel: 0031104639222 Fax: 0031104634757 E-mail: vanvugt@hlkd.azr.nl

© 2004 Lippincott Williams & Wilkins, Inc.