http://journals.lww.com/spinejournal...ely.98488.aspx
Should Symptomatic Iliac Screws be Electively Removed in Adult Spinal Deformity Patients Fused to the Sacrum?
O’Shaughnessy, Brian A. M.D.; Lenke, Lawrence G. M.D.; Bridwell, Keith H. M.D.; Cho, Woojin M.D., Ph.D.; Zebala, Lukas P. M.D.; Chang, Michael S. M.D.; Auerbach, Joshua D. M.D.; Crawford, Charles H. M.D.; Koester, Linda A. B.S.
Published Ahead-of-Print
Abstract
STRUCTURED ABSTRACT: Study Design. Retrospective, single institution, review of adult deformity patients fused to the sacrum that underwent iliac screw (IS) removal.
Objective. To demonstrate if iliac screw removal offered benefit in terms of hip/buttock pain overlying the iliac screw and could be removed without significant complications.
Summary of Background Data. Iliac screws are effective at countering cantilever forces imparted on sacral pedicle screws. Despite the efficacy of IS fixation, pain or implant prominence can lead to elective IS removal. There has been no study about IS removal in adult spinal deformity patients.
Methods. 395 consecutive ambulatory adult spinal deformity patients fused to the sacrum with IS fixation and minimum 2-year follow-up met study inclusion criteria. Clinical/radiographic data were analyzed. Since there is no validated pain outcomes instrument specific to this situation, an 8-question IS removal questionnaire was designed and utilized for the sole purpose of this inquiry, within which a universally accepted numeric rating scale for pain is included.
Results. 24/395 (6.1%) patients (2M/22F) with mean age 50.5+/-10.8 years underwent elective IS removal at mean 2.6+/-1.3 years from index surgery. Mean follow-up from initial surgery was 6.3+/-4.0 years. Symptoms included hip/buttock pain in all 24 patients and IS prominence in 5 patients (20.8%). Screw removal was bilateral in 18 (75%) and unilateral in 6 (25%). Using a numeric rating pain scale (0-10), 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 im p roved" (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.
Conclusions. Of 395 consecutive ambulatory patients who had iliac screws placed during fusion to the sacrum for adult spinal deformity, 24 (6.1%) underwent elective removal. Patients had a statistically significant improvement in hip/buttock pain after IS removal and a low prevalence of complications following the procedure was observed.
(C) 2011 Lippincott Williams & Wilkins, Inc.
O’Shaughnessy, Brian A. M.D.; Lenke, Lawrence G. M.D.; Bridwell, Keith H. M.D.; Cho, Woojin M.D., Ph.D.; Zebala, Lukas P. M.D.; Chang, Michael S. M.D.; Auerbach, Joshua D. M.D.; Crawford, Charles H. M.D.; Koester, Linda A. B.S.
Published Ahead-of-Print
Abstract
STRUCTURED ABSTRACT: Study Design. Retrospective, single institution, review of adult deformity patients fused to the sacrum that underwent iliac screw (IS) removal.
Objective. To demonstrate if iliac screw removal offered benefit in terms of hip/buttock pain overlying the iliac screw and could be removed without significant complications.
Summary of Background Data. Iliac screws are effective at countering cantilever forces imparted on sacral pedicle screws. Despite the efficacy of IS fixation, pain or implant prominence can lead to elective IS removal. There has been no study about IS removal in adult spinal deformity patients.
Methods. 395 consecutive ambulatory adult spinal deformity patients fused to the sacrum with IS fixation and minimum 2-year follow-up met study inclusion criteria. Clinical/radiographic data were analyzed. Since there is no validated pain outcomes instrument specific to this situation, an 8-question IS removal questionnaire was designed and utilized for the sole purpose of this inquiry, within which a universally accepted numeric rating scale for pain is included.
Results. 24/395 (6.1%) patients (2M/22F) with mean age 50.5+/-10.8 years underwent elective IS removal at mean 2.6+/-1.3 years from index surgery. Mean follow-up from initial surgery was 6.3+/-4.0 years. Symptoms included hip/buttock pain in all 24 patients and IS prominence in 5 patients (20.8%). Screw removal was bilateral in 18 (75%) and unilateral in 6 (25%). Using a numeric rating pain scale (0-10), 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 im p roved" (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.
Conclusions. Of 395 consecutive ambulatory patients who had iliac screws placed during fusion to the sacrum for adult spinal deformity, 24 (6.1%) underwent elective removal. Patients had a statistically significant improvement in hip/buttock pain after IS removal and a low prevalence of complications following the procedure was observed.
(C) 2011 Lippincott Williams & Wilkins, Inc.
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