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The Effect of Sacral Alar Screw on Long-level Fusion Including Lumbosacral Segment

  • Journal of Korean Society of Spine Surgery
  • Abbr : J Kor Spine Sur
  • 2011, 18(3), pp.146-152
  • Publisher : Korean Society Of Spine Surgery
  • Research Area : Medicine and Pharmacy > Orthopedic Surgery

정재윤 1 강경도 1 Hyoung-Yeon Seo 1 Yim, Ji hyun 1 Kim Sung Kyu 2 LEE GUN-WOO ORD ID 1

1전남대학교
2전남대학교병원

Accredited

ABSTRACT

Study Design: This is a retrospective study. Objectives: To evaluated the clinical and radiological effectiveness of sacral alar screws for augmentation of S1 pedicle screws in longlevel fusion including L5-S1 segment. Summary of Literature Review: The fusion rates of lumbosacral junction in long-level fusion are various when S1 pedicle screws are used without augmentation. But, reports of sacral alar screw augmentation are rare. Material and Methods: From 1996 to 2005, 63 patients performed more than two-level fusion including lumbosacral junction were reviewed. 47 patients underwent lumbosacral fusion with S1 pedicle screws only (S1 group), and 16 patients with sacral alar screws augmentation in addition to S1 pedicle screws (S1-2 group). Radiologically, bony union, halo sign, and breakage of implants were evaluated. Clinically, complications associated with screw placement and general complications were evaluated. Results: Bony union was obtained in 56 cases(89%) at postoperative 4.3 months. Nonunion was observed in 7 cases(11%, S1 group:5,S1-2 group:2). Loosening of S1 pedicle screw was observed in 32 cases(89%) of S1 group and in 4 cases(25%) of S1-2 group. It showed statistical significance between two groups. Sacral alar screw loosening occurred in 8 cases(50%) of S1-2 group. Metal breakage was developed in 2 cases of S1 group without nonunion or loosening. Postoperative infection occurred in 7 cases(11%, S1 group:5, S1-2group:2). Conclusions: Sacral alar screw augmentation was effective on protecting the loosening of S1 pedicle screw. Additional sacral alar screw can improve the rate of fusion for lumbosacral junction despite no statistical significance. Key Words: Lumbosacral fusion, Long level fusion, Sacral alar screw augmentation

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