Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters

Yao Zhang; Jipeng Song; Yuzheng Lu; Meng Yi; Wancheng Lin; Mingtao Yao; Zhengning Luo; Genai Zhang; Lixiang Ding

doi:10.1186/s12891-023-06552-1

Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters

BMC Musculoskelet Disord. 2023 Jun 2;24(1):451. doi: 10.1186/s12891-023-06552-1.

Authors

Yao Zhang¹, Jipeng Song¹, Yuzheng Lu¹, Meng Yi¹, Wancheng Lin¹, Mingtao Yao¹, Zhengning Luo¹, Genai Zhang¹, Lixiang Ding²

Affiliations

¹ Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China.
² Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China. dinglx@bjsjth.cn.

Abstract

Background: Management of high-grade spondylolisthesis (HGS) remains challenging. Spinopelvic fixation such as iliac screw (IS) was developed to deal with HGS. However concerns regarding constructs prominence and increased infection-related revision surgery have complicated it's use. We aim to introduce the modified iliac screw (IS) technique in treating high-grade L5/S1 spondylolisthesis and it's clinical and radiological outcomes.

Methods: Patients with L5/S1 HGS who underwent modified IS fixation were enrolled. Pre- and postsurgical upright full spine radiographs were obtained to analyze sagittal imbalance, spinopelvic parameters, pelvic incidence-lumbar lordosis mismatch (PI-LL), slip percentage, slip angle (SA), and lumbosacral angle (LSA). Visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated pre- and postoperatively for clinical outcomes assessment. Estimated blood loss, operating time, perioperative complications and revision surgery were documented.

Results: From Jan 2018 to March 2020, 32 patients (15 males) with mean age of 58.66 ± 7.77 years were included. The mean follow-up period was 49 months. The mean operation duration was 171.67 ± 36.66 min. At the last follow-up: (1) the VAS and ODI score were significantly improved (p < 0.05), (2) PI increased by an average of 4.3°, the slip percent, SA and LSA were significantly improved (p < 0.05), (3) four patients (16.7%) with global sagittal imbalance recovered a good sagittal alignment, PI-LL within ± 10° was observed in all patients. One patient experienced wound infection. One patient underwent a revision surgery due to pseudoarthrosis at L5/S1.

Conclusion: The modified IS technique is safe and effective in treating L5/S1 HGS. Sparing use of offset connector could reduce hardware prominence, leading to lower wound infection rate and less revision surgery. The long-term clinical affection of increased PI value is unknown.

Keywords: High grade spondylolisthesis; Iliac screw; Spinal sagittal imbalance; Spino-pelvic parameter; Spinopelvic fixation.

MeSH terms

Adult
Aged
Bone Screws
Humans
Lordosis* / etiology
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / surgery
Male
Middle Aged
Retrospective Studies
Spinal Fusion* / adverse effects
Spinal Fusion* / methods
Spondylolisthesis* / diagnostic imaging
Spondylolisthesis* / etiology
Spondylolisthesis* / surgery
Treatment Outcome