Bilateral dual iliac screws in spinal deformity correction surgery

Area of Science:

• Orthopedic Surgery
• Spinal Fusion Techniques
• Biomechanical Engineering

Background:

• Adult spinal deformity correction requires precise spino-pelvic-lower extremity alignment.
• Sacro-pelvic fixation is critical for thoracolumbar spinal deformity surgery with sacral fusion.
• Previous sacro-pelvic fixation methods using S1 and single iliac screws had high rates of loosening.

Purpose of the Study:

• To evaluate the efficacy and safety of using bilateral dual iliac screws and S1 pedicle screws for spinal and pelvic fusion.
• To assess the stability and complication rates of this novel fixation technique in adult spinal deformity patients.

Main Methods:

• Twenty-seven adult spinal deformity patients underwent thoracolumbar-pelvic correction with bilateral double iliac screws.
• Radiographic and CT assessments of spino-pelvic parameters were performed preoperatively and at 24 months postoperatively.
• Complications including screw loosening and iliac perforation were evaluated at 2 years postoperatively.

Main Results:

• Low rates of iliac screw loosening (7.4% at 1 year, 11.1% at 2 years) and S1 screw loosening (11.1% at 2 years) were observed.
• Iliac screw displacement occurred in 25% of cases, with internal and external iliac perforation in 22.2% and 11.1% respectively.
• One reoperation was required due to iliac screw back-out and rod breakage.

Conclusions:

• Bilateral dual iliac screws with S1 pedicle screws provide enhanced stability for spinal and pelvic fusion in adult spinal deformity.
• This technique demonstrates a favorable complication profile for long-term spinal fusion.