gms | German Medical Science

Objective: The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum. Our focus were patients with multilevel degenerative spine disease and the need for a multilevel correction and stabilization with a solid basal foundation.

Method: We included a total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7,0 ± 3,3) with a minimum of 1 year follow-up. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back pain reduction, overall extent of disability after surgery (Oswestry Disability Index: ODI ) and the number of complications.

Results: The incidence of L5-S1 pseudarthrosis after one year in the S1, iliac, and plate groups was 19%, 0%, 29%, respectively (p<0.05 iliac vs. plate). The incidence of screw loosening after one year in the S1, iliac, and plate groups was 22%, 4%, 43%, respectively (p<0.05 iliac vs. Plate). Average Oswestry scores after one year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, 58 ± 18, respectively (p<0.05 both S1 and iliac vs. Plate). The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous spine surgeries, postoperative complication rate or length of the hospital stay.

Conclusions: The surgical treatment of multilevel degenerative spine disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of iliac screws resulted in a superior surgical and clinical outcome when compared to the sacroiliac plate device.