Neurosurgery Resident Inova Neuroscience and Spine Institute Fairfax, VA, US
Disclosure(s):
Luke Mugge, MD: No financial relationships to disclose
Introduction: Pelvic fixation (PF) is commonly employed for long-segment adult spinal deformity (ASD) constructs that span the lumbosacral junction. However, distal failure remains problematic despite the use of PF. Multipoint PF may reduce distal failure but limited data exists on the feasibility and safety of this strategy.
Methods: A single-center, consecutive series of ASD patients treated with multipoint PF were retrospectively analyzed. Multipoint PF was defined as ≥2 fixation points on each side of the pelvis. Baseline demographics, radiographic measurements, surgical treatment details, PROMs and 90-day complications were collected. Implant malposition and sacropelvic fractures were assessed by post-operative CT.
Results: 45 ASD patients with multipoint PF were included. Mean construct length was 9.4 levels with a mean number of rods used of 3.75. 35 cases (78%) included an implant for sacroiliac joint fusion. Surgical navigation assisted in the placement of PF for 97.8% of cases. Mean EBL was 1151cc. 15 cases had radiographic evidence of sacropelvic fractures, and 10 cases had a screw breach identified. No patient required reoperation for implant malposition or fracture at 90 days. The 90-day readmission rate was 8.8%. Post-operative major and minor complications occurred in 13.2% of cases. Post-operative transient lower extremity motor and sensory deficits occurred in 20% and 4.4% of cases, respectively. 11.1% of patients demonstrated improvements in their motor examination post-operatively, and 13.3% of patients with reported baseline deficits did not have further improvement. All patients reported improvements in both ODI (57.47 vs 32.53, p= 0.03) and SF-36 (41.80 vs 25.42 post op, p= 0.01).
Conclusion : Multipoint PF in the treatment of ASD is feasible and without an appreciable increase in perioperative complications. Sacropelvic fractures or minor violations of the pelvic cortical surfaces are commonly encountered but largely asymptomatic. Indications for multipoint PF strategies and long-term outcomes are of interest for future research.