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Should Symptomatic Iliac Screws be Electively Removed in Postoperative Adult Spinal Deformity Patients Fused to the Sacrum?: Paper #106

O'Shaughnessy, Brian A. MD (Washington University School of Medicine); Lenke, Lawrence G. MD; Bridwell, Keith H. MD; Kuklo, Timothy R. MD, JD; Cho, Woojin MD; Chang, Michael S. MD; Auerbach, Joshua D. MD; Crawford, Charles H. MD; Koester, Linda A.

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Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 127–128
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Introduction: Iliac screws (IS) are an effective method to counter cantilever forces imparted on sacral fixation. Pain or implant prominence can lead to elective IS removal. Our purpose was to determine: (1) the prevalence of elective IS removal in adult spinal deformity; (2) if symptoms improved after IS removal; (3) complications of IS removal.

Methods: 395 consecutive ambulatory adult deformity patients fused to the sacrum with IS at a single institution were studied. All patients had min 2‐year f/u. Clinical‐radiographic data was analyzed. An 8‐question IS removal questionnaire was specially designed and utilized.

Results: 24/395 (6.1%) patients (2M/22F) with mean age 50.5±10.8 years underwent elective IS removal 2.6±1.3 years from the index operation. Mean follow‐up from initial surgery was 6.3±4.0 years. Hip/buttock pain was present in all 24 patients; 5 patients (20.8%) also reported IS prominence. Removal was bilateral in 18 (79.2%) and unilateral in 5 patients (20.8%). Using a (0–10) NRS pain scale, hip/buttock pain improved following IS removal: preop 6.9±1.8, postop 2.0±2.7 (p<0.05). Patients reported hip/buttock symptoms post‐IS removal as: “much improved” (78.3%), “somewhat improved” (8.7%), and “unchanged” (13.0%). 2/24 (8.3%) patients sustained complications from IS removal (wound infection n=1; coronal/sagittal imbalance n=1). Presented with the same set of circumstances, 22/24 (91.7%) of patients would have their IS removed again, including one of the patients who had a complication.

Conclusion: In the adult spinal deformity population, the prevalence of elective IS removal was 6.1% at an average of 2.6±1.3‐yrs postop. IS removal was associated with a low rate of complications, a high rate of hip/buttock pain relief (86.0% of patients were improved), and 91.7% overall satisfaction in well selected adult spinal deformity patients.

Significance: Elective iliac screw removal due to pain or prominence is uncommon following surgery for adult spinal deformity. In carefully selected patients, elective removal of iliac screws results in a significant improvement in hip/buttock pain and high overall satisfaction, with a low risk of complications.

© 2009 Lippincott Williams & Wilkins, Inc.