Se-Jun Park, Kyunghun Jung, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Chong-Suh Lee
{"title":"在韩国的一项回顾性研究中，髂螺钉失效会影响成人脊柱畸形手术的长期影像学和临床结果，而不会阻碍腰骶交界处的融合。","authors":"Se-Jun Park, Kyunghun Jung, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Chong-Suh Lee","doi":"10.31616/asj.2025.0006","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery.</p><p><strong>Overview of literature: </strong>Iliac fixation is crucial for long-segmental fusion in ASD surgery to prevent mechanical failure at the lumbosacral junction. Despite numerous studies on ISF, its impact on surgical outcomes remains unclear.</p><p><strong>Methods: </strong>We included 192 patients (mean age, 69.2 years; mean follow-up, 57.8 months) who underwent ≥5-level fusion with interbody fusion at L5-S1 and pelvic fixation using bilateral iliac screws between 2014 and 2022. Patients were categorized into no-ISF and ISF groups. Fusion status at L5-S1 was evaluated using computed tomography (CT) images at 2 years postoperatively. Mechanical failures (evaluated in terms of rod fractures and related revision surgery), radiographic outcomes, and clinical outcomes were compared between the groups.</p><p><strong>Results: </strong>ISFs developed in 66 patients (34.4%) by 13.4 months post-surgery on average. At 2-year CT follow-up, no significant differences in fusion grades were observed between the two groups. ISF rates did not differ according to mechanical failure development in terms of rod fracture at L5-S1 (p =0.273) or at ≥L4-5 (p =0.432), or revision surgery at L5-S1 (p =0.144) or at ≥L4-5 (p =0.886). However, at the final follow-up, sagittal parameters, including pelvic incidence, were significantly worse in the ISF group than in the no-ISF group. The final clinical outcomes were also poorer in the ISF group.</p><p><strong>Conclusions: </strong>ISF occurred in over one-third of patients after long-segment fusion. While ISF did not adversely affect radiographic and clinical fusion achievement at the lumbosacral junction, it was associated with inferior long-term radiographic and clinical outcomes.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Iliac screw failures compromise long-term radiographic and clinical outcomes of adult spinal deformity surgery without impeding fusion at the lumbosacral junction: a retrospective study in Korea.\",\"authors\":\"Se-Jun Park, Kyunghun Jung, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Chong-Suh Lee\",\"doi\":\"10.31616/asj.2025.0006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery.</p><p><strong>Overview of literature: </strong>Iliac fixation is crucial for long-segmental fusion in ASD surgery to prevent mechanical failure at the lumbosacral junction. Despite numerous studies on ISF, its impact on surgical outcomes remains unclear.</p><p><strong>Methods: </strong>We included 192 patients (mean age, 69.2 years; mean follow-up, 57.8 months) who underwent ≥5-level fusion with interbody fusion at L5-S1 and pelvic fixation using bilateral iliac screws between 2014 and 2022. Patients were categorized into no-ISF and ISF groups. Fusion status at L5-S1 was evaluated using computed tomography (CT) images at 2 years postoperatively. Mechanical failures (evaluated in terms of rod fractures and related revision surgery), radiographic outcomes, and clinical outcomes were compared between the groups.</p><p><strong>Results: </strong>ISFs developed in 66 patients (34.4%) by 13.4 months post-surgery on average. At 2-year CT follow-up, no significant differences in fusion grades were observed between the two groups. ISF rates did not differ according to mechanical failure development in terms of rod fracture at L5-S1 (p =0.273) or at ≥L4-5 (p =0.432), or revision surgery at L5-S1 (p =0.144) or at ≥L4-5 (p =0.886). However, at the final follow-up, sagittal parameters, including pelvic incidence, were significantly worse in the ISF group than in the no-ISF group. The final clinical outcomes were also poorer in the ISF group.</p><p><strong>Conclusions: </strong>ISF occurred in over one-third of patients after long-segment fusion. While ISF did not adversely affect radiographic and clinical fusion achievement at the lumbosacral junction, it was associated with inferior long-term radiographic and clinical outcomes.</p>\",\"PeriodicalId\":8555,\"journal\":{\"name\":\"Asian Spine Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Spine Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.31616/asj.2025.0006\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2025.0006","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Iliac screw failures compromise long-term radiographic and clinical outcomes of adult spinal deformity surgery without impeding fusion at the lumbosacral junction: a retrospective study in Korea.
Study design: A retrospective study.
Purpose: To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery.
Overview of literature: Iliac fixation is crucial for long-segmental fusion in ASD surgery to prevent mechanical failure at the lumbosacral junction. Despite numerous studies on ISF, its impact on surgical outcomes remains unclear.
Methods: We included 192 patients (mean age, 69.2 years; mean follow-up, 57.8 months) who underwent ≥5-level fusion with interbody fusion at L5-S1 and pelvic fixation using bilateral iliac screws between 2014 and 2022. Patients were categorized into no-ISF and ISF groups. Fusion status at L5-S1 was evaluated using computed tomography (CT) images at 2 years postoperatively. Mechanical failures (evaluated in terms of rod fractures and related revision surgery), radiographic outcomes, and clinical outcomes were compared between the groups.
Results: ISFs developed in 66 patients (34.4%) by 13.4 months post-surgery on average. At 2-year CT follow-up, no significant differences in fusion grades were observed between the two groups. ISF rates did not differ according to mechanical failure development in terms of rod fracture at L5-S1 (p =0.273) or at ≥L4-5 (p =0.432), or revision surgery at L5-S1 (p =0.144) or at ≥L4-5 (p =0.886). However, at the final follow-up, sagittal parameters, including pelvic incidence, were significantly worse in the ISF group than in the no-ISF group. The final clinical outcomes were also poorer in the ISF group.
Conclusions: ISF occurred in over one-third of patients after long-segment fusion. While ISF did not adversely affect radiographic and clinical fusion achievement at the lumbosacral junction, it was associated with inferior long-term radiographic and clinical outcomes.
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