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Study Design: This is a retrospective study., Objective: To report the safety profile of S2-alar-iliac (S2AI) in patients over 60, comparing S2AI screws with iliac screws (ISs)., Summary of Background Data: The surgical management involving the lumbosacropelvic spine remains a challenge due to high mechanical demand and risk of pseudarthrosis. Previous articles showed lower rates of complications in patients receiving S2AI screws than ISs; however, none of them have focused on patients aged over 60 who may harbor significant comorbidities and thus require more meticulous perioperative management, given these invasive and lengthy procedures., Materials and Methods: Retrospective review of clinical records from 2010 to 2015 identified 60 patients undergoing lumbosacropelvic fixation (17 patients with ISs and 43 patients with S2AI screws) who satisfied the following criteria: (1) patients aged over 60 years old and (2) patients with >1-year follow-up periods. Rates of complications such as unplanned reoperation and cardiorespiratory complications were collected and statistically analyzed., Results: Baseline characteristics such as age, sex, and comorbidities were similar in both groups. The S2AI group had lower rates of reoperation (18.6% vs. 47.4%; P=0.02), surgical site infection (2.3% vs. 29.4%; P=0.006), wound dehiscence (2.3% vs. 29.4%; P=0.006), and postoperative anemia (7.0% vs. 29.4%; P=0.03) and had lower total volume of estimated blood loss (EBL) (mL) (1846.4 vs. 2721.2; P=0.02) and transfused red blood cell units (7.2 vs. 4.7; P=0.04) than the IS group, while rates of L5-S1 pseudarthrosis and other cardiorespiratory complications were similar in both groups. In multivariate analysis, operative time, body mass index, and use of S2AI screws over ISs were independent predictors of EBL., Conclusions: Use of S2AI screws over ISs in patients aged over 60 was associated with lower rates of reoperation, surgical site infection, wound dehiscence, and lower volume of EBL and red blood cell transfusion and is a viable surgical option.

Study Design: Retrospective comparative study., Objective: To compare clinical and radiographic outcomes between the S2-alar-iliac (S2AI) and the iliac screw (IS) techniques in the adult population and clarify the clinical strength of S2AI screws., Summary of Background Data: S2AI screws have been described as an alternative method for lumbosacropelvic fixation in place of ISs. The S2AI technique has several advantages with lower prominence, increased ability to directly connect to proximal instrumentation, less extensive dissection of tissue, and enhanced biomechanical strength over the IS technique. However, the clinical significance of these advantages remains unclear., Methods: A single-center retrospective review of patients who underwent lumbosacropelvic fixation yielded 25 IS group patients and 65 S2AI group patients. Baseline demographic information, postoperative complications, pain and functional outcomes, and screw-related outcomes were collected., Results: The S2AI group had lower rates of reoperation (8.8% vs. 48.0%, P < 0.001), surgical site infection (SSI) (1.5% vs. 44.0%, P < 0.001), wound dehiscence (1.5% vs. 36.0%, P < 0.001), and symptomatic screw prominence (0.0% vs. 12.0%, P = 0.02) than the IS group, whereas rates of L5-S1 pseudarthrosis, proximal junctional failure, and sacroiliac joint pain were similar in both groups. Statistically significant pain relief and functional recovery were achieved in both groups without any significant intergroup differences. On multivariate analyses, age [odds ratio (OR) = 0.91, P = 0.004] and S2AI instrumentation (OR = 0.08, P < 0.001) were protective of reoperation, whereas diabetes mellitus (OR = 10.9, P = 0.03) and preoperative diagnosis of tumor (OR = 12.3, P = 0.04) were associated with SSI, and S2AI instrumentation (OR = 0.09, P < 0.001) was protective of SSI., Conclusion: The use of the S2AI technique over the IS technique was an independent predictor of preventing reoperation and SSI, while achieving similar clinical and functional outcomes., Level of Evidence: 4.

Background: In sacropelvic fixation, the iliac screw technique offers biomechanically strong constructs, but its disadvantages include screw prominence, wound dehiscence, and postoperative pain secondary to the high profile nature. To overcome this drawback, S2-alar-iliac (S2AI) screws were developed as an alternative technique for sacropelvic fixation. This study aimed to compare the S2AI screw technique with the iliac screw technique in terms of postoperative symptomatic screw prominence., Methods: A retrospective review of the records of sacropelvic fusion procedures performed at a single institution between October 2010 and January 2015 identified 32 patients with 72 iliac screws and 68 patients with 148 S2AI screws, and clinical and radiographic data were collected. If a patient had wound dehiscence and/or tenderness in the buttock immediately overlying a pelvic screw head postoperatively, it was defined as symptomatic screw prominence. The minimal distance from screw head to skin (MDSS) on postoperative computed tomography scans was measured for each patient to clarify the relationship between symptomatic screw prominence and MDSS., Results: Mean follow-up period was 22.0 months. There was significantly more symptomatic pelvic screw prominence in the iliac screw group (11.1% vs. 1.4%, P = 0.002). MDSS ≤23 mm was the strongest predictor of symptomatic pelvic screw prominence, which yielded sensitivity of 100%, specificity of 94.1%, positive predictive value of 47.6%, and negative predictive value of 100%., Conclusions: The use of the S2AI screw technique resulted in a reduced rate of symptomatic screw prominence. MDSS ≤23 mm was the strongest predictor of symptomatic screw prominence., (Published by Elsevier Inc.)

BACKGROUND CONTEXT The surgical management of deformity, degenerative pathology, neoplasms, trauma and infection in the lumbosacropelvic spine remains a challenge due to high mechanical demand around this area, risks of pseudarthrosis, and invasive nature of the procedures. To date, two instrumentation techniques are primarily available: iliac screws (ISs) and S2-alar-iliac (S2AI) screws. Previous articles demonstrated lower rates of complications with S2AI screws as compared to ISs; however, none of them have focused on elderly patients who may harbor significant comorbidities, and as such, require more meticulous perioperative management, given these invasive and lengthy procedures. PURPOSE To report safety profile of S2AI in patients over 60 and address differences between S2AI screws and ISs. STUDY DESIGN/SETTING Single-center, retrospective, case-control study. PATIENT SAMPLE Single center, retrospective cohort who underwent lumbosacropelvic fixation with more than two-year follow-up. OUTCOME MEASURES Rates of complications such as mortality, unplanned reoperation, cardiorespiratory complications, transfusion-related complications and functional outcome measures such as visual analogue scale for back pain. METHODS Between October 2010, and December 2014, 171 sacropelvic fusion procedures with IS or S2AI screw instrumentation were performed in 161 patients. The inclusion criteria for this study were as follows: (1) patients over 60years old and (2) patients with more than two-year follow-up periods, which yielded 15 patients (IS) and 41 cases (S2AI), respectively. Rates of complications such as mortality, unplanned reoperation, pseudoarthrosis, cardiorespiratory complications, transfusion-related complications and functional outcome measures such as visual analogue scale for back pain and ambulatory status were collected and statistically analyzed. Intergroup comparison of binary variables was performed via Fisher's exact test. Intergroup comparison of continuous variables was achieved using unpaired t-tests. For the analyses on pain and functional outcomes, the perioperative comparisons for each group and intergroup comparisons were conducted using the Wilcoxon signed-rank test and the Mann–Whitney U test, respectively. All reported p values are 2-sided and p values <.05 were regarded as statistically significant. RESULTS Baseline characteristics such as age, sex, smoking history, diagnoses and comorbidities were similar in both groups. The S2AI group had lower rates of reoperation (19.5% vs 66.6%, p=.002), surgical site infection (0% vs. 16.0%, p<.001), wound dehiscence (0.0% vs. 20.0%, p<.001) and postoperative hyperkalemia (17.7% vs. 43.8%, p=.04) and had lower volume of estimated blood loss (EBL) [ml] (1817.5vs. 2775.6, p=.01) and transfused red blood cell units (4.6vs. 8.0, p=.001) than the IS group, while rates of mortality, L5-S1 pseudarthrosis, and other cardiorespiratory complications were similar in both groups. Pain relief and functional recovery were achieved in both groups without any significant intergroup differences. On multivariate analyses, use of S2AI screws over ISs, smoking, and operated levels were independent predictors of volume of transfusion. CONCLUSIONS Use of S2AI screws over ISs in the elderly was associated with lower rates of reoperation, surgical site infection, wound dehiscence and lower volume of EBL and RBC transfusion, while achieving similar clinical and functional outcomes. [ABSTRACT FROM AUTHOR]