gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Tear-drop technique in iliac screw placement – a technical analysis

Tear-Drop-Technik in Platzierung von Ilium-Schrauben – eine technische Analyse

Meeting Abstract

  • presenting/speaker Stephan Nowak - Universitätsmedizin Greifswald, Neurochirurgie, Greifswald, Deutschland
  • Jonas Müller - Universitätsmedizin Greifswald, Neurochirurgie, Greifswald, Deutschland
  • Martin E. Weidemeier - Universitätsmedizin Greifswald, Neurochirurgie, Greifswald, Deutschland
  • Henry W. S. Schroeder - Universitätsmedizin Greifswald, Neurochirurgie, Greifswald, Deutschland
  • Jan-Uwe Müller - Universitätsmedizin Greifswald, Neurochirurgie, Greifswald, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP031

doi: 10.3205/20dgnc322, urn:nbn:de:0183-20dgnc3225

Veröffentlicht: 26. Juni 2020

© 2020 Nowak et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Instrumentation of the lumbosacral region is due to the complex anatomical structures and biomechanical forces one of the more challenging techniques. It could already be demonstrated that in order to enhance the fusion rate of the lumbosacral junction additional iliac screw placement is necessary. Numerous techniques have been described for iliac screw placement. Not only open surgical techniques with anatomic guidance, but also navigated or robotic supported placement have been described. These techniques, if applied correctly, have the advantage to give the surgeon an extra reference for safety at the cost of prolonged operative time and cost. That is why we adapted at our neurosurgical spine-center a fast and simple radiological controlled open placement technique for iliac screw fixation.

Methods: Between October 2016 and august 2019 48 patients underwent sacropelvic fixation in tear-drop-technique. To indicate surgery generally applied world standards were used in every specific case. Screw position was verified with a 3d x-ray-scan intra-operatively. Follow-up x-ray was performed before discharge and 3 months after surgery. The data was collected prospectively. The chart review was done retrospectively. The statistical analysis was done by using excel and SPSS for Windows.

Results: Between October 2016 and August 2019 we included 48 patients. The mean age was 64 years (27-81 years). In total, 95 iliac screws were placed in tear-drop-technique. Only in one side (1.04%) navigated placement was performed due to tumor deformed iliac anatomy. The mean follow-up was 9.8 months. Spinal instrumentation was performed due to degenerative spinal scoliosis in 22 cases (45.8%), in equal number (22 cases; 45.8%) a revision surgery after previous spinal instrumentation necessitated a spinopelvic fusion. All these cases received a multi-level spinal instrumentation. In all cases (98.9%) but one the 3d x-ray scan after tear-drop screw placement confirmed a correct position of the screw. Only in one case there was a lateral breach of the screw head. In the three-month follow up there were no complications regarding the iliac screws. Other surgical complications included post-operative infection in 4 cases (8.3%), non-fusion of the upper and mid-level in 4 cases (8.3%) and fractured pedicel screw on level L2 in one case (2.1%).

Conclusion: The tear-drop-technique for iliac screw placement in spinal surgery is a fast, reliable and safe method only utilizing single x-ray imaging and minimal exposure.

Figure 1 [Fig. 1]