The aim of lumbopelvic fixation is to obtain a solid fusion across the lumbosacral junction. There are many indications for lumbopelvic fixation, namely, spinal deformity in cases requiring long segment fusion, pelvic obliquity, pseudarthrosis at the lumbosacral junction, infection or osteolytic tumors, and pathologic fractures. The classical iliac screws should be contained within the iliac bone but have some disadvantages: excessive soft tissue dissection needed for accurate insertion, screw prominence with patient discomfort, and usually, a side connector is needed to connect the iliac screws to the rest of the construct. Lumbopelvic fixation by insertion of S2 alar-iliac (S2AI) screws was recently described to overcome these disadvantages. In this study, the authors present the initial results for the evaluation of lumbopelvic fixation through the insertion of S2AI screws in 19 consecutive patients operated in the neurosurgery department at Alexandria University. The aim of the study was to evaluate the efficacy and complications of lumbopelvic fixation through the use of S2 alar-iliac screws. The authors conducted a retrospective cohort study of data collected from the database of patients who underwent lumbopelvic fixation through the insertion of S2AI screws from 2016 to 2019 at a single institution. There were 19 patients indicated for lumbopelvic fixation, operated by modern instrumentation systems using lumbar pedicle screws and S2 alar-iliac screws. There were 14 females and 5 males. The mean age at the time of the operation was 38.6 ± 19.4 years with a range from 11 to 65 years. There was a total of 37 S2AI screws, screw diameter was 7mm in all cases regardless of age, and the length of the screws ranged from 50 mm in a young female patient (11 years) to 90 mm in an old male patient (60 years). Two screws were inserted per patient except in one case with congenital scoliosis due to the bad bone quality and the multiple iatrogenic wrong paths. Postoperative VAS score for back pain was greatly improved in all patients after the first 6 months of follow-up from 8 ± 1.5 to 3.5 ± 1.2 (paired t-test = 11.182, P<0.001). All patients had a good spinal range of motion to maintain normal daily activities without any significant restrictions after the first 3 months of follow-up. Immediate postoperative radiological follow-up had revealed 2 cases of posterior pelvic breaches and one case with anterior pelvic breach but without clinical manifestations with no need for revision. Two cases of unilateral screw breakout were observed after the first 6 months of follow-up. Removal of screws after the first 6 months was done in one patient with spondylodiscitis due to the unresolved infection and screw pullout. The insertion of S2AI screws is an effective technique for lumbopelvic fixation with a relatively low rate of complications. Pelvic breaches are the commonest complications encountered during the insertion of S2AI screws, although no significant clinical morbidities were reported.

中文翻译：

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亚历山大大学腰骨盆固定技术的早期体验

腰椎骨盆固定的目的是在腰骶结合处获得牢固的融合。腰椎骨盆固定的适应证有很多，即需要长节段融合的脊柱畸形、骨盆倾斜、腰骶结合部假关节、感染或溶骨性肿瘤、病理性骨折。经典的髂骨螺钉应包含在髂骨内，但有一些缺点：准确插入需要过度解剖软组织，螺钉突出导致患者不适，通常需要侧连接器将髂骨螺钉连接到结构的其余部分. 最近描述了通过插入 S2 alar-iliac (S2AI) 螺钉进行腰骨盆固定以克服这些缺点。在这项研究中，作者展示了在亚历山大大学神经外科手术的 19 名连续患者中通过插入 S2AI 螺钉评估腰骨盆固定的初步结果。该研究的目的是评估通过使用 S2 鼻翼-髂骨螺钉进行腰骨盆固定的疗效和并发症。作者对从 2016 年至 2019 年在单个机构通过插入 S2AI 螺钉进行腰骨盆固定的患者数据库中收集的数据进行了一项回顾性队列研究。有 19 名患者需要腰骨盆固定，使用现代器械系统使用腰椎椎弓根螺钉和 S2 鼻翼-髂骨螺钉进行手术。有14名女性和5名男性。手术时的平均年龄为 38.6 ± 19.4 岁，范围为 11 至 65 岁。总共有37颗S2AI螺钉，无论年龄大小，螺钉直径均为7mm，螺钉长度从年轻女性患者（11岁）的50毫米到老年男性患者（60岁）的90毫米不等。 ）。除 1 例先天性脊柱侧凸由于骨质量差和多处医源性错误路径外，每位患者均植入 2 颗螺钉。所有患者的术后腰痛 VAS 评分在前 6 个月的随访后从 8 ± 1.5 提高到 3.5 ± 1.2（配对 t 检验 = 11.182，P < 0.001）。所有患者都有良好的脊柱运动范围，可以在前 3 个月的随访后维持正常的日常活动，没有任何明显的限制。术后即刻影像学随访发现 2 例骨盆后裂，1 例骨盆前裂，但无临床表现，无需翻修。在随访的前 6 个月后观察到 2 例单侧螺钉断裂。一名因感染未解决和螺钉拔出而患有椎间盘炎的患者在头 6 个月后取出螺钉。S2AI螺钉置入是一种有效的腰椎骨盆固定技术，并发症发生率相对较低。骨盆裂口是 S2AI 螺钉置入过程中最常见的并发症，尽管没有报告显着的临床并发症。一名因感染未解决和螺钉拔出而患有椎间盘炎的患者在头 6 个月后取出螺钉。S2AI螺钉置入是一种有效的腰椎骨盆固定技术，并发症发生率相对较低。骨盆裂口是 S2AI 螺钉置入过程中最常见的并发症，尽管没有报告显着的临床并发症。一名因感染未解决和螺钉拔出而患有椎间盘炎的患者在头 6 个月后取出螺钉。S2AI螺钉置入是一种有效的腰椎骨盆固定技术，并发症发生率相对较低。骨盆裂口是 S2AI 螺钉置入过程中最常见的并发症，尽管没有报告显着的临床并发症。