The Effect of Sacral Alar Screw on Long-level Fusion Including Lumbosacral Segment (요천추분절을 포함한 장분절 유합술시 사용한 천추익 나사못의 효과)

정재윤; 강경도; Hyoung-Yeon Seo (서형연); Yim, Ji hyun (임지현); Kim Sung Kyu (김성규); LEE GUN-WOO (이건우)

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 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

KEYWORDS

Lumbosacral fusion, Long level fusion, Sacral alar screw augmentation

Citation status

* References for papers published after 2023 are currently being built.

[journal] Cunningham BW / 2002 / Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model / Spine (Phila Pa 1976) 27 : 2321~2327

[journal] Grobler LJ / 1993 / Biomechanics of lumbar spine surgery / Semin Spine Surg 5 : 59~72

[journal] Grubb SA / 1992 / Results of lumbosacral fusion for degenerative disc disease with and without instrumentation. Two-to five-year follow-up / Spine (Phila Pa 1976) 17 : 349~355

[journal] Kornblatt MD / 1986 / Internal fixation in lumbosacral spine fusion. A biomechanical and clinical study / Clin Orthop Relat Res 203 : 141~150

[journal] Lonstein JE / 1994 / The Galveston technique using Luque or Cotrel-Dubousset rods / Orthop Clin North Am 25 : 311~320

[journal] Johnston CE 2nd / 1990 / Effect of spinal construct stiffness on early fusion mass incorporation. Experimental study / Spine (Phila Pa 1976) 15 : 908~912

[journal] Lee CS / 2010 / Critical Length of Fusion Requiring Additional Fixation to Prevent Nonunion of the Lumbosacral Junction / Spine (Phila Pa 1976) 6 : 206~211

[journal] Ashman RB / 1998 / Mechanical testing of spinal instrumentation / Clin Orthop Relat Res 227 : 113~125

[journal] Ashman RB / 1993 / Mechanical testing of spinal implants / Semin Spine Surg 15 : 79~

[journal] Bernhardt M / 1992 / Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation / Clin Orthop Relat Res 284 : 109~115

[journal] Carlson GD / 1992 / Screw fixation in the human sacrum. An in vitro study of the biomechanics of fixation / Spine (Phila Pa 1976) 17(6 Suppl) : 196~203

[journal] Jackson R / 1994 / Intrasacral fixation and segmental corrections with adjustable contoured translating axes / Spine State Art Rev 8 : 307~341

[journal] Lenke LG / 1992 / Results of in situ fusion for isthmic spondylolisthesis / J Spinal Disord 5 : 433~442

[journal] Hambly MF / 1998 / The transition zone above a lumbosacral fusion / Spine (Phila Pa 1976) 23 : 1785~1792

[journal] Esses SI / 1991 / Surgical anatomy of the sacrum. A guide for rational screw fixation / Spine (Phila Pa 1976) 16(6 Suppl) : 283~288

[journal] Ogilvie JW / 1986 / Comparison of lumbosacral fixation devices / Clin Orthop Relat Res 203 : 120~125

[journal] Camp JF / 1990 / Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study / Spine (Phila Pa 1976) 15 : 932~941

[journal] Devlin VJ / 1991 / Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation / J Spinal Disord 4 : 1~14

[journal] Perra JH / 1994 / Techniques of instrumentation in long fusions to the sacrum / Orthop Clin North Am 25 : 287~299

[journal] McKinley TO / 1999 / Characteristics of pedicle screw loading. Effect of surgical technique on intravertebral and intrapedicular bending moments / Spine (Phila Pa 1976) 24 : 18~24

[journal] Ogon M / 1996 / Comparison between single-screw and triangulated, double-screw fixation in anterior spine surgery. A biomechanical test / Spine (Phila Pa 1976) 21 : 2728~2734

[journal] Leong JC / 1998 / Comparison of the strengths of lumbosacral fixation achieved with techniques using one and two triangulatedsacral screws / Spine (Phila Pa 1976) 23 : 2289~2294

[journal] Horton WC / 1996 / Controversy. Fusion of L5-S1 in adult scoliosis / Spine (Phila Pa 1976) 21 : 2520~2522

[journal] Shin BJ / 1999 / Survivorship analysis of pedicle screw fixation / J Korean Soc Spine Surg 6 : 355~361

[journal] Shin BJ / 2000 / Radiologic results of posterior lumbosacral fixation according to sacral fixation methods-single screw vs double screws / J Korean Soc Spine Surg 7 : 15~21

[journal] Kim EH / 2002 / Long Segment Fusion to L5 Vertebra and Sacral Vertebra in Degenerative Lumbar Spine / J Korean Soc Spine Surg 9 : 216~222

[journal] Kuklo TR / 2001 / Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws / Spine (Phila Pa 1976) 26 : 1976~1983

[journal] Smith SA / 1993 / The effects of depth of penetration, screw orientation, and bone density on sacral screw fixation / Spine (Phila Pa 1976) 18 : 1006~1010

[journal] Halvorson TL / 1994 / Effects of bone mineral density on pedicle screw fixation / Spine (Phila Pa 1976) 19 : 2415~2420

[journal] 김진환 / 2006 / Deep Infection following Instrumented Posterior Fusion / 대한정형외과학회지 / 대한정형외과학회 41(4) : 617~622

KJCKorea
Journal Central

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03