SI Joint Publications

The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up

Nakashima H, Kanemura T, Satake K, Ito K, Ishikawa Y, Ouchida J, Segi N, Yamaguchi H, Imagama S.
Asian Spine J. 2019 Nov 5.
PMID: 31679321  DOI: 10.31616/asj.2019.0127. [Epub ahead of print]


Study Design: A retrospective cohort study.

Purpose: the purpose of this study was to investigate the prevalence and risk factors for S2 alar-iliac (SAI) screw loosening following lumbosacral fixation, with a minimum 2-year follow-up

Overview of Literature: Although SAI screws allow surgeons to perform lumbosacralfixation with a low profile and enhanced biomechanical strength, screwloosening following surgery can occur in some cases. However, few studies have investigated the prevalence and risk factors for SAI screw loosening.

Methods: This retrospective study included 35 patients (mean age, 72.8±8.0 years; male, 10; female, 25) who underwent lumbosacral fixation using SAI screws with at least 2 years of follow-up. SAI screw loosening and L5-S bony fusion were assessed using computed tomography. The period for which the screws appeared loose and the risk factors for SAI screw loosening were investigated 2 years after surgery.

Results: A total of 70 SAI screws and 70 S1 pedicle screws were inserted. Loosening was observed 0.5, 1, and 2 years after surgery in 17 (24.3%), 35 (50.0%), and 35 (50.0%) SAI screws, respectively. Bony fusion rate at L5-S was significantly lower in patients with SAI screw loosening than in those without screw loosening (65.0% vs. 93.3%, p =0.048). The score for SAI screw contact with the iliac cortical bone and the bony fusion rate at L5-S were significantly lower in the loosening group than in the non-loosening group (1.8±0.5 vs. 2.2±0.3, p <0.001, respectively). Postoperative pelvic incidence-lumbar lordosis was significantly higher in the loosening group than in the non-loosening group (7.9°±15.4° vs. 0.5°±8.7°, p =0.02, respectively).

Conclusions: SAI screw loosening is closely correlated with pseudoarthrosis at L5-S. Appropriate screw insertion and optimal lumbar lordosis restoration are important to prevent postoperative complications related to SAI screws.

KEYWORDS: Bony fusion; Risk factors; S2 alar-iliac screw; Screw loosening

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