Study design: Surgical technique description.
Objective: To describe a surgical technique of ilio-lumbar fixation with iliac screws, which attempts to overcome some of the current limitations and technical difficulties associated with this surgery.
Summary of background data: The iliac screw technique, which is the most commonly used method of ilio-lumbar fixation, has certain limitations that need special consideration. These include soft tissue coverage, improving the strength of distal anchorage, reducing hardware prominence, avoiding complex 3-dimensional rod contouring, preventing neurologic injury, and acetabular violation.
Materials and results: Over the past 5 years, we have used our technique in 8 patients (4 sacral tumors, 2 fracture dislocations, and 2 spinal tuberculosis). In 6 cases, the sacrum was not available for anchoring and hence was bypassed. The follow-up ranged from 3 to 54 months, and 5 patients had resumed normal activities. In 7 cases, the wound healed primarily and the solitary wound failure was in a previously irradiated skin. Other complications like neurologic deficit secondary to the procedure, acetabular violation, and implant failure were not encountered.
Conclusions: Our technique of ilio-lumbar fixation provides a stable and simple alternative to reconstruct potentially devastating instability of the lumbosacral junction. The 2 iliac screws, when used as described, make the procedure technically easier, reduce the hardware prominence without compromising the stability to construct and provide adequate bone graft.