Peculiarities of spinopelvic fixation in deformations and traumatic injuries of the spine

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Abstract

AIM: to evaluate the effectiveness of spinal pelvic fixation with screws inserted through the S2 vertebra into the ilium (S2AIS technique) and the use of individual pelvic support plates.

METHODS. The analysis of the results of performing spinal-pelvic fixation in 74 patients with various pathologies of spine column and traumatic injuries (66 patients — S2AIS technique, 8 patients — fixation with individually made implants) was carried out.

RESULTS. The long-term follow-up period for the patient averaged 23.5 months (from 6 to 48 months). In the group of patients with fixation using the S2AIS method, the absence of complications, requiring repeated treatment, and stable fixation in the long-term follow-up period was noted in 53 cases (78.7%). The overall incidence of malpositions out of the total number of screws established was 4.3%; only one case (0.7%) required reoperation. Fracture of the metal implant rod at the L5-S1 level (15.2%), fracture of the screws in the ilium (5%) and instability of fixation with resorption of bone tissue around the screws in the S1 vertebra and in the ilium (3%). With fixation using individual support plates, stable fixation of spinopelvic fixation in the long-term period was achieved in 5 cases; in three cases, the implants had to be removed.

CONCLUSION. Installation of iliac screws using the S2AIS technique is the optimal method of spinopelvic fixation, allowing reliable fixation with minimal complications. In cases where traditional methods of spinopelvic fixation are impossible or technically difficult, fixation with customized implants is possible.

About the authors

Marchel S. Vetrile

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: vetrilams@cito-priorov.ru
ORCID iD: 0000-0001-6689-5220
SPIN-code: 9690-5117

traumatologist-orthopedist

Russian Federation, 10 Priorova str., Moscow, 127299

Alexander A. Kuleshov

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito-spine@mail.ru
ORCID iD: 0000-0002-9526-8274
SPIN-code: 7052-0220

PhD

Russian Federation, 10 Priorova str., Moscow, 127299

Sergey N. Makarov

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: moscow.makarov@gmail.com
ORCID iD: 0000-0003-0406-1997
SPIN-code: 2767-2429

PhD, traumatologist-orthopedist

Russian Federation, 10 Priorova str., Moscow, 127299

Igor N. Lisyansky

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: lisigornik@list.ru
ORCID iD: 0000-0002-2479-4381
SPIN-code: 9845-1251

traumatologist-orthopedist

Russian Federation, 10 Priorova str., Moscow, 127299

Alexey I. Kokorev

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: leo-strelec@mail.ru
ORCID iD: 0000-0002-5829-6372
SPIN-code: 7734-8476

traumatologist-orthopedist

Russian Federation, 10 Priorova str., Moscow, 127299

Nikolay A. Aganesov

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: kolyanzer@yandex.ru
ORCID iD: 0000-0001-5383-6862
SPIN-code: 1805-5790

traumatologist-orthopedist

Russian Federation, 10 Priorova str., Moscow, 127299

Vitaly R. Zakharin

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: zakhvit@gmail.com
ORCID iD: 0000-0003-1553-2782

traumatologist-orthopedist

Russian Federation, 10 Priorova str., Moscow, 127299

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Supplementary files

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2. Fig. 1. Patient K., 21 years old. Diagnosis: Congenital left-sided thoracolumbar kyphoscoliosis. Operation: resection of the T12-L1 hemivertebra, dorsal deformity correction and spinopelvic fixation using the S2AIS method: a — radiographs before surgery; b — CT reconstruction after surgery

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3. Fig. 2. Patient O., 9 years old. Neurofibromatosis. Deformation of the lumbosacral spine and pelvis: a — X-ray and CT reconstruction before surgery; b — computer model, design of an individual implant; c — a sterolithographic model with an installed custom design; d — X-ray and CT-reconstruction after performing spinopelvic fixation with an individual implant

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4. Fig. 3. Unilateral malposition of the screw in the ilium according to CT with penetration of the inner wall, which did not affect the clinical outcome of the operation and did not require reoperation

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5. Fig. 4. Patient 55 years old, idiopathic scoliosis: a — satisfactory position of screws in the ilium according to CT with insignificant unilateral penetration of the outer wall; b — fracture of the metal rods at the L5-S1 level one year after the operation, which required repeated surgery

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