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Comparison of Sacral-Alar-Iliac and Iliac-Only Methods of Pelvic Fixation in Early-Onset Scoliosis at 5.8 Years' Mean Follow-up.
Spine Deform 2019; 7(2):364-370SD

Abstract

STUDY DESIGN

Retrospective.

OBJECTIVE

Compare clinical outcomes in early-onset scoliosis (EOS) patients treated with sacral-alar-iliac (SAI) versus iliac-only methods of pelvic fixation at two years' minimum follow-up.

SUMMARY OF BACKGROUND DATA

Pelvic fixation in EOS is challenged by poor bone, anchor migration, and displacement. The long-term outcomes of SAI fixation in EOS is unknown.

METHODS

We retrospectively reviewed EOS patients in a single center from 2000 to 2017. Inclusion criteria were posterior spinal instrumentation with pelvic fixation before age 10 and 2 years' minimum follow-up. Clinical and radiographic data were analyzed using chi-squared and Student t tests (significance defined as p <.05).

RESULTS

Seven subjects were included in the iliac-only fixation group (Galveston technique = 2, iliac screws = 5) and 17 in the SAI group. For the iliac-only group (mean follow-up = 6.8 years), pelvic obliquity improved from a mean of 18° at initial presentation to 11° at first instrumentation (p = .096), to 9° at end follow-up (p = .060), whereas the major curve improved correspondingly from a mean of 84° to 50° (p = .002) to 39° (p = .006). For the SAI group (mean follow-up = 5.5 years) at the same time points, pelvic obliquity improved from a mean of 25° to 6° (p <.001) to 5° (p <.001), whereas the major curve improved from a mean of 83° to 38° (p <.001) to 29° (p <.001). SAI fixation was associated with fewer complications (11 complications in 17 patients) compared to iliac-only fixation (10 complications in 7 patients) (p = .04). Neither method was associated with pelvic growth disturbances or neurologic deficits.

CONCLUSIONS

In EOS patients at 2 years' minimum (5.8 years' mean) follow-up, both SAI and iliac-only methods corrected major curve, only SAI fixation corrected pelvic obliquity, and neither was associated with pelvic growth disturbances. SAI fixation was also associated with fewer complications. These findings may be due to the length and direction of the SAI anchors and abutment on the iliac cortex.

LEVEL OF EVIDENCE

Level III.

Authors+Show Affiliations

Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, USA. Electronic address: ecottri1@jhmi.edu.Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, USA.Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, USA.Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30660234

Citation

Cottrill, Ethan, et al. "Comparison of Sacral-Alar-Iliac and Iliac-Only Methods of Pelvic Fixation in Early-Onset Scoliosis at 5.8 Years' Mean Follow-up." Spine Deformity, vol. 7, no. 2, 2019, pp. 364-370.
Cottrill E, Margalit A, Brucker C, et al. Comparison of Sacral-Alar-Iliac and Iliac-Only Methods of Pelvic Fixation in Early-Onset Scoliosis at 5.8 Years' Mean Follow-up. Spine Deform. 2019;7(2):364-370.
Cottrill, E., Margalit, A., Brucker, C., & Sponseller, P. D. (2019). Comparison of Sacral-Alar-Iliac and Iliac-Only Methods of Pelvic Fixation in Early-Onset Scoliosis at 5.8 Years' Mean Follow-up. Spine Deformity, 7(2), pp. 364-370. doi:10.1016/j.jspd.2018.08.007.
Cottrill E, et al. Comparison of Sacral-Alar-Iliac and Iliac-Only Methods of Pelvic Fixation in Early-Onset Scoliosis at 5.8 Years' Mean Follow-up. Spine Deform. 2019;7(2):364-370. PubMed PMID: 30660234.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Sacral-Alar-Iliac and Iliac-Only Methods of Pelvic Fixation in Early-Onset Scoliosis at 5.8 Years' Mean Follow-up. AU - Cottrill,Ethan, AU - Margalit,Adam, AU - Brucker,Cameron, AU - Sponseller,Paul D, PY - 2018/01/08/received PY - 2018/07/02/revised PY - 2018/08/12/accepted PY - 2019/1/21/entrez PY - 2019/1/21/pubmed PY - 2019/7/3/medline KW - Early-Onset Scoliosis (EOS) KW - Iliac fixation KW - Pelvic fixation KW - Sacral-Alar-Iliac (SAI) KW - Spinal deformity SP - 364 EP - 370 JF - Spine deformity JO - Spine Deform VL - 7 IS - 2 N2 - STUDY DESIGN: Retrospective. OBJECTIVE: Compare clinical outcomes in early-onset scoliosis (EOS) patients treated with sacral-alar-iliac (SAI) versus iliac-only methods of pelvic fixation at two years' minimum follow-up. SUMMARY OF BACKGROUND DATA: Pelvic fixation in EOS is challenged by poor bone, anchor migration, and displacement. The long-term outcomes of SAI fixation in EOS is unknown. METHODS: We retrospectively reviewed EOS patients in a single center from 2000 to 2017. Inclusion criteria were posterior spinal instrumentation with pelvic fixation before age 10 and 2 years' minimum follow-up. Clinical and radiographic data were analyzed using chi-squared and Student t tests (significance defined as p <.05). RESULTS: Seven subjects were included in the iliac-only fixation group (Galveston technique = 2, iliac screws = 5) and 17 in the SAI group. For the iliac-only group (mean follow-up = 6.8 years), pelvic obliquity improved from a mean of 18° at initial presentation to 11° at first instrumentation (p = .096), to 9° at end follow-up (p = .060), whereas the major curve improved correspondingly from a mean of 84° to 50° (p = .002) to 39° (p = .006). For the SAI group (mean follow-up = 5.5 years) at the same time points, pelvic obliquity improved from a mean of 25° to 6° (p <.001) to 5° (p <.001), whereas the major curve improved from a mean of 83° to 38° (p <.001) to 29° (p <.001). SAI fixation was associated with fewer complications (11 complications in 17 patients) compared to iliac-only fixation (10 complications in 7 patients) (p = .04). Neither method was associated with pelvic growth disturbances or neurologic deficits. CONCLUSIONS: In EOS patients at 2 years' minimum (5.8 years' mean) follow-up, both SAI and iliac-only methods corrected major curve, only SAI fixation corrected pelvic obliquity, and neither was associated with pelvic growth disturbances. SAI fixation was also associated with fewer complications. These findings may be due to the length and direction of the SAI anchors and abutment on the iliac cortex. LEVEL OF EVIDENCE: Level III. SN - 2212-1358 UR - https://www.unboundmedicine.com/medline/citation/30660234/Comparison_of_Sacral_Alar_Iliac_and_Iliac_Only_Methods_of_Pelvic_Fixation_in_Early_Onset_Scoliosis_at_5_8_Years'_Mean_Follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-134X(18)30174-6 DB - PRIME DP - Unbound Medicine ER -