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. 2024 Feb 4;11(2):199.
doi: 10.3390/children11020199.

Pelvic Fixation Technique Using the Ilio-Sacral Screw for 173 Neuromuscular Scoliosis Patients

Mathilde Gaumé  1   2 , Elie Saghbiny  1 , Lou Richard  1 , Clélia Thouement  1 , Raphaël Vialle  1 , Lotfi Miladi  2
Affiliations

Pelvic Fixation Technique Using the Ilio-Sacral Screw for 173 Neuromuscular Scoliosis Patients

Mathilde Gaumé et al. Children (Basel). .

Abstract

Pelvic fixation remains one of the main challenging issues in non-ambulatory neuromuscular scoliosis (NMS) patients, between clinical effectiveness and a high complication rate. The objective of this multicenter and retrospective study was to evaluate the outcomes of a technique that was applied to treat 173 NMS patients. The technique is not well-known but promising; it uses the ilio-sacral screw, combined with either the posterior spinal fusion or fusionless bipolar technique, with a minimum follow-up of two years. The mean operative age of the patients was 13 ± 7 years. The mean preoperative main coronal curve was 64° and improved by a mean of -39° postoperatively. The mean preoperative pelvic obliquity was 23°, which improved by a mean of -14° postoperatively. No decrease in the frontal or sagittal correction was observed during the last follow-up. The sitting posture improved in all cases. Twenty-nine patients (17%) had a postoperative infection: twenty-six were treated with local debridement and antibiotics, and three required hardware removal. Fourteen mechanical complications (8%) occurred: screw malposition (n = 6), skin prominence (n = 1), and connector failure (n = 1). This type of surgery is associated with a high risk for infection. Comorbidities, rather than the surgery itself, were the main risk factors that led to complications. The ilio-sacral screw was reliable and effective in correcting pelvic obliquity in NMS patients. The introduction of intraoperative navigation should minimize the risk of screw misplacement and facilitate revision or primary fixation.

Keywords: ilio-sacral screw; minimally invasive fusionless surgery; neuromuscular scoliosis; pelvic fixation; pelvic obliquity; posterior spinal fusion.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The ilio-sacral screw with the connector.
Figure 2
Figure 2
Preoperative X-rays and clinical pictures of a SMA2 patient.
Figure 3
Figure 3
Postoperative X-rays and clinical pictures of the same patient, after minimally invasive fusionless surgery.
Figure 4
Figure 4
Posterior spinal fusion with ilio-sacral screws.
Figure 5
Figure 5
Pre- and postoperative X-rays after posterior spinal fusion.
See this image and copyright information in PMC

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