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Thread: Elective iliac screw removal decreases pain

  1. #1
    Join Date
    Jan 2008

    Elective iliac screw removal decreases pain

    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

    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.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine

    "We are all African."

  2. #2
    Join Date
    May 2008

    This is good news....the few forum members here that have had this done have reported good outcomes. I hope they will correct me if I’m wrong.

    My long pelvic screws might look scary, but I have had zero pain down low. None at all. Hard to believe since my lower spine was in pretty bad shape. Dr Menmuir pulled it off and I still cant believe it!

    Upon thinking about this, I think about bone pain and “sensory neurons” and their location. Positioning and placement of any screws must play an important part.

    49 yr old male, now 63, the new 64...
    Pre surgery curves T70,L70
    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion

    My x-rays

  3. #3
    Join Date
    Mar 2008
    New Bern, NC
    Thanks for posting this study. I have a lot of hip/buttock pain and this give me new hope that I could have this done and feel a whole lot better.
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F.

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  4. #4
    Join Date
    Apr 2012
    Harrisburg, Pa.
    Quote Originally Posted by loves to skate View Post
    Thanks for posting this study. I have a lot of hip/buttock pain and this give me new hope that I could have this done and feel a whole lot better.
    Sally....Did you ever have your iliac screw removed? Patty
    1963 Fusion T4-L2 for congenital scoliosis. It was a bone graft and not instrumentation
    1989 to Present....Have had chronic pain. MRI's show severe neural foraminal stenosis L2-S1, rotational scoliosis lumbar spine over 40 degrees, compression of nerve roots L5-S1, Broad Based Herniations L4-L5, L5-S
    Surgery scheduled with Dr. Bridwell on December 11, 2012
    December 11, 2012 Had surgery with Dr. Bridwell. He fused L4-L5 with rods and screws.

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