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A Comparison of Clinical Stability of Distal Instrument Fused Down to S1 with and without Sub-S1 Alar Screw in the Long Fusion using Segmental Pedicle Screw for Lumbar Degenerative Deformity

  • Journal of Korean Society of Spine Surgery
  • Abbr : J Kor Spine Sur
  • 2010, 17(3), pp.139-146
  • Publisher : Korean Society Of Spine Surgery
  • Research Area : Medicine and Pharmacy > Orthopedic Surgery

김진혁 1 김성수 2 임동주 3 한정일 4 김태형 1 박찬근 1 석세일 3

1인제대 상계백병원
2인제대학교 일산백병원
3인제대학교
4인제대학교 상계 백병원

Accredited

ABSTRACT

Study Design: This is a retrospective study. Objectives: We wanted to assess the stability of distal instrumentation using the bilateral S1 and sacral alar screws for the treatment of degenerative lumbar deformity. Summary of the Literature Review: Various instrumentation methods have been introduced for increasing the strength of lumbosacral fusion. However, there are not many clinical studies that have evaluated the effectiveness of a sub-S1 alar screw for treating degenerative lumbar deformity surgery. Materials and Methods: A total of 39 patients with degenerative lumbar deformity were treated by long fusion and we retrospectively analyzed these patients after a minimum follow-up of 1 year. All the patients underwent an operation with distal instrumentation using either bilateral S1 screws alone (the S1 group) or additional bilateral sub-S1 sacral alar screws (the SA group). There were 19 patients in the S1 group and 20 patients in the SA group. The stability of the distal instrumentation was assessed by breakage or backout of a rod and/or screws based on simple radiography. Results: Instability of the distal instrumentation was detected in 6 cases (32%) in the S1 group and in 1 case (5%) in the SA group. The SA group had a more stability of the distal instrumentation than that of the S1 group with a significant difference (P<0.05). Distal instrumentation was unstable in 6 (19%) of the 32 cases with an anterior metal cage through posterior interbody fusion at L5-S1 and in 1(14%) of 7 cases without it at L5-S1. There was no significant difference in the stability of distal instrumentation in each group according to whether or not their L5-S1 was treated with an interbody cage (P>0.05). Conclusions: Bilateral sacral alar screws coupled with bilateral S1 screws can provide good distal fixation for stability of the distal instrumentation when performing long fusion for treating degenerative lumbar deformity.

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