Observations on Sagittal Alignment of Lumbo-Sacral Spine in Asymptomatic Adults in Kashmir

Introduction: Sacropelvic parameters in various spine and hipdisorders have been published in various studies. We aimed tostudy the normal sacropelvic parameters and curvatures of thespine and their correlation in asymptomatic Indian adults inrelation to variations in sex and age.Material and Methods: 200 Volunteers were taken fromgeneral population with age ranging from 18-50. Patientwas made to stand and left lateral radiograph exposing C7 toS1 and both the hips with a long 30x90 cm cassette placedat 230 cm from the X-ray tube was performed by a singleradiographer to avoid bias.Results: The average LL, SS, PI, PT, and SVA values wereaverage 55.61±10.68, 38.38±8.33,47.94±10.24,10.16±6.23 and 17.27±9.72 respectively. No statistically significantdifference was observed in statistical values with regardsto sex. Our study showed that PI has significant positivecorrelations with SS, LL and PT, and also affects LL. SS hassignificant positive correlation with LL.Conclusion: The current results could contribute to not onlythe understanding of normal sagittal spinal alignment, but alsoserve as a basis for realignment strategies in young Kashmiriadults.

Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw: Technical Case Series

OBJECTIVE: Among the various sacropelvic fixation methods, S2 alar-iliac (S2AI) screw fixation has several advantages compared to conventional iliac wing screw. However, the placement of S2AI screw still remains a challenge. The purpose of this study was to describe a novel technique of free hand S2AI screw insertion using a K-wire and cannulated screw, and to evaluate the accuracy of the technique.METHODS: S2AI screw was inserted by free hand technique in sixteen consecutive patients without any fluoroscopic guidance. The gearshift was advanced to make a pilot hole passing through the sacroiliac joint and directing the anterior inferior iliac spine. A K-wire was placed through the pilot hole. After introducing a cannulated tapper along with the K-wire, a cannulated S2AI screw was installed over the K-wire.RESULTS: Thirty-three S2AI screws were placed in sixteen consecutive patients. Thirty-two screws were cannulated screws, and one screw was a conventional non-cannulated screw. Thirty out of 32 (93.8%) cannulated screws were accurately positioned, whereas two cannulated screws and one non-cannulated screw violated lateral cortex of the ilium.CONCLUSION: The technique using K-wire and cannulated screw can provide accurate placement of free hand S2AI screw.

Percutaneous S2-alar-iliac screw fixation for lower lumbar spondylodiscitis with no neurological symptoms in elderly patients: analysis of short-term curative effect / 介入放射学杂志

Objective To evaluate the short-term efficacy of percutaneous S2-alar-iliac screw (S2AIS) fixation for the treatment of lower lumbar spondylodiscitis with no neurological symptoms in elderly patients.Methods The clinical data of 28 patients of lower lumbar spondylodiscitis with no neurological symptoms,who were admitted to the Ward of Spine,Department of Orthopaedics,General Hospital of Shenyang Military Region,China,to receive percutaneous S2AIS fixation,were retrospectively analyzed.The operation was performed by the same surgeon for all patients.A total of 56 S2AIS fixation procedures were accomplished.The patients' age varied from 71 to 79 years old.The spondylodiscitis was located at IAL5 or L5-S1.After the treatment,the patients were followed up for a mean of 6.67 months.The mean operative time,the amount of intraoperative blood loss,the postoperative bed time,the average hospitalization days and the postoperative wound healing were documented and analyzed.The Oswestry score,visual analogue score,erythrocyte sedimentation rate,C reactive protein level were determined before operation as well as at one week and 6 months after operation,and postoperative CT was performed to check the loosening of internal screw fixation.The results were compared and analyzed.Results The mean operative time was (158.12±4.32) min,the average amount of intraoperative blood loss was (25.34±3.23) ml,the average postoperative bed time was (1.34±0.35) d,and the average hospitalization time was (7.29±1.34) d.Poor surgical incision healing was seen in only one patient,and the postoperative wound healing rate was up to 96.42％.Loosening of right S2AIS was detected in one patient,with the screw loosening rate being 1.79％.The Oswestry scores determined at one week and 6 months after treatment were 32.21 and 23.20 respectively,which were significantly different from the preoperative score (P＜0.05).The visual analogue scores determined at one week and 6 months after treatment were 2.17 and 1.25 respectively,which were significantly different from the preoperative score (P＜0.05).At one week and 6 months after treatment,the erythrocyte sedimentation rates were 15.32 mm/h and 14.56 mm/h respectively,and the C reactive protein levels were 7.89 mg/L and 8.90 mg/L respectively,both of which were significantly different from the preoperative ones (both P＜0.05).Conclusion For the treatment of lower lumbar spondylodiscitis with no neurological symptoms in elderly patients,percutaneous S2AIS fixation has certain advantages,such as less trauma,less blood loss,early postoperative ambulation,remarkable improvement of clinical symptoms,etc.with satisfactory short-term clinical efficacy.

Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw: Technical Case Series

OBJECTIVE: Among the various sacropelvic fixation methods, S2 alar-iliac (S2AI) screw fixation has several advantages compared to conventional iliac wing screw. However, the placement of S2AI screw still remains a challenge. The purpose of this study was to describe a novel technique of free hand S2AI screw insertion using a K-wire and cannulated screw, and to evaluate the accuracy of the technique. METHODS: S2AI screw was inserted by free hand technique in sixteen consecutive patients without any fluoroscopic guidance. The gearshift was advanced to make a pilot hole passing through the sacroiliac joint and directing the anterior inferior iliac spine. A K-wire was placed through the pilot hole. After introducing a cannulated tapper along with the K-wire, a cannulated S2AI screw was installed over the K-wire. RESULTS: Thirty-three S2AI screws were placed in sixteen consecutive patients. Thirty-two screws were cannulated screws, and one screw was a conventional non-cannulated screw. Thirty out of 32 (93.8%) cannulated screws were accurately positioned, whereas two cannulated screws and one non-cannulated screw violated lateral cortex of the ilium. CONCLUSION: The technique using K-wire and cannulated screw can provide accurate placement of free hand S2AI screw.

Comparison of clinical complications of iliac screw fixation versus S2 alar-iliac screw / 局解手术学杂志

Objective To compare the clinical complications between S2 alar-iliac(S2AI) screw and iliac screw(IS) fixation technique.Methods The data of 65 patients who were diagnosed as degenerative scoliosis and underwent spinopelvic fixation in our hospital from August 2010 to July 2012 were retrospectively reviewed.These patients were divided into the iliac screw fixation group (IS group) with 43 patients and the S2 alar iliac fixation group (S2AI group) with 22 patients according to different methods.The complications included screw loosening,screw breakage,acute infections,delayed wound infection and persistent pain over the gluteal region occurring longer than 3 months postoperatively were recorded.Results There were 8cases with screw loosening and 13 cases with gluteal pain in IS group,while there were no screw loosening and only 2 cases with gluteal pain in S2AI group.The average onset of gluteal pain were 11.8 months postoperatively in the IS group and 18 months postoperatively in the S2AI group.It showed that the absolute risk reduction(ARR) of screw loosening and late pain in the S2AI group was 18.6%,which was lower than 21.1% in the IS group. In the IS group, there were a total of 5 cases of delayed wound infection. Finally,3 caes of them were cured by irrigation and debridement only.and the other 2 cases were cured by irrigation and debridement with implant removal.There were no cases of delayed wound infection in the S2AI group.Conclusion The S2AI technique is associated with significantly less clinical and radiographic complications when compared with the iliac screws technique,it is a kind of internal fixation of spine and pelvis,which is worthy of being popularized by spine surgeons.

Sagittal Sacropelvic Morphology and Balance in Patients with Sacroiliac Joint Pain Following Lumbar Fusion Surgery

OBJECTIVE: To investigate the sagittal sacropelvic morphology and balance of the patients with SIJ pain following lumbar fusion. METHODS: Among 452 patients who underwent posterior lumbar interbody fusion between June 2009 and January 2013, patients with postoperative SIJ pain, being responded to SIJ block were enrolled. For a control group, patients matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. Patients were assessed radiologic parameters including lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). To evaluate the sagittal sacropelvic morphology and balance, the ratio of PT/PI, SS/PI and PT/SS were analyzed. RESULTS: A total of 28 patients with SIJ pain and 56 patients without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (p=0.02) than non-SIJ pain group. Postoperatively, PT/PI and SS/PI in SIJ pain group was significantly greater and smaller than those in non-SIJ pain group respectively (p=0.03, 0.02, respectively) except for PT/SS (p=0.05). SIJ pain group did not show significant postoperative changes of PT/PI and SS/PI (p=0.09 and 0.08, respectively) while non-SIJ pain group showed significantly decrease of PT/PI (p=0.00) and increase of SS/PI (p=0.00). CONCLUSION: This study presents different sagittal sacropelvic morphology and balance between the patients with/without SIJ pain following lumbar fusion surgery. The patients with SIJ pain showed retroversed pelvis and vertical sacrum while the patients without SIJ pain have similar morphologic features with asymptomatic populations in the literature.

Significance of Pelvic Incidence in the Development of Abnormal Sagittal Alignment / 대한정형외과학회잡지

PURPOSE: Under the assumption that the pelvic incidence influences the development of an abnormal curvature, this study examined the relationship between the pelvic incidence and the development of an abnormal curvature. MATERIALS AND METHODS: Twenty-two adults with a normal curvature and seventy-nine adults with an abnormal curvature were enrolled in this study. All subjects were older than fifty years of age at the time of the study. The patients were classified based on the alignment of the spine and the strategic vertebrae as follows: extension of the lordosis of the lumbar spine to the upper part of the thoracolumbar transitional portion (Group 1), kyphosis on the lower lumbar area but an extension of the lordosis from the upper lumbar area to the upper part of the thoracolumbar transitional portion (Group 2), extension of the kyphosis from the thoracic spine to the lower lumbar area (Group 3), the presence of lordosis on the lower lumbar portion but an extension of the kyphosis from the upper lumbar portion to the upper portion of the thoracolumbar area (Group 4). In each group, the interrelationship between the sagittal alignment, pelvic tilt, sacral slope and pelvic incidence were evaluated, and the changes in the numerical figures were compared and analyzed. RESULTS: In the normal group the average pelvic incidence was 52.5 degrees. The average pelvic incidence was higher in groups 1 and 2 (61.6 and 58.5 degrees, respectively) than in groups 3 and 4 (44.5 and 47.2 degrees, respectively) (p<0.001). The average sacral slope was 31.5 in the normal group, 34.5 in group 1, 25.1 in group 4, 20.1 in group 2, and 9.2 in group 3. In groups 1 and 2, group 2 showed a lower sacral slope compared with group 1 (p<0.001). In groups 3 and 4, group 4 had a larger sacral slope than group 3 (p<0.001). The average pelvic tilt was 21 in the normal group. Groups 2 and 3 showed a larger pelvic tilt (38.4 and 35.3, respectively) than that of groups 1 and 4 (27.1 and 22.1, respectively). CONCLUSION: In the elderly with an abnormal lordotic curve, the sagittal alignment of the spine is associated with the pelvic tilt, sacral slope and pelvic incidence, in a similar manner to that in normal adults with a normal lordotic curve. Therefore, measuring these figureswould help in making an estimate of the perspective changes in the sagittal alignment of spine.