261 - Minimally Invasive Iliac Screw Fixation as a Palliative Surgical Optio...

General Session: MIS-2

Presented by: G. Liu - View Audio/Video Presentation (Members Only)

Author(s):

G. Liu(1), M.Y. Hasan(1), H.K. Wong(1)

(1) National University Health System, University Orthopaedics and Hand Cluster, Singapore, Singapore

Abstract

Introduction: Pelvic fixation via iliac screws is a crucial technique in stabilizing metastatic lumbosacral deformity. MIS iliac screw fixation avoids complications of an open approach and is a viable palliative option in treating patients with painful instability and advanced disease, unsuited for major reconstruction. In this study we share our clinical experience in the use of MIS iliac screw fixation in treatment of painful metastatic LSJ deformity.

Methods: Seven patients with lumbosacral metastatic deformity who underwent MIS lumbopelvic stabilization using iliac screws were prospectively studied. At presentation these patients had severe axial back pain in erect posture with significant resolution when supine, indicating underlying mechanical instability.

Results: Mean cohort age was 58 years (27-73). Median preop SIN and Tokuhashi scores were 13 and 9 respectively. All patients were instrumented successfully without conversion to open technique, with two cases needing decompression. Mean preoperative and postoperative Cobb angle was 10° and 4.2° respectively. There were no neurological deficits or wound complications postop. Postoperative CT scans showed no iliac-screw and sacroiliac joint bony violation. Mean time for commencement of adjuvant therapy was 2.6 weeks. At 6-month follow-up the visual analogue score (VAS) for each case was considerably better than at preop (median scores for back and leg were 3 and 2 respectively) Average follow-up was 12 months (8-20). No screw breakage, wound complication, symptomatic implant prominence and SI joint pain were noted at last spine surgery follow-up. Five patients from our series have since passed away from their underlying metastatic disease.

Conclusion: MIS iliac-screw fixation is feasible, reproducible and can be employed without complications in metastatic spine without dynamic neurological deficits. This opens a new avenue of surgical management for metastatic lumbosacral disease patients, who otherwise may be inoperable and provide better soft-tissue control and earlier postoperative adjuvant treatment opportunity.