فيكساسيون ساكروم با استفاده از پيچ هاي ساكرال در بيماران بستري در بخش ارتوپدي بيمارستان سينا

Treatment of spinal diseases with fusion to the sacrum using CD instrumentation and screw fixation

Study design: This is a retrospective review of a consecutive series of patients with spinal disease who underwent posterior fusion and sacral fixation with different methods. Objective: To evaluate different methods of sacral fixation. Summary of background data: Spinal diseases that require posterior fusion and CD instrumentation with sacral fixation, pose one of the challenging instrumentation problems, mainly because of the poor bone quality frequently found within the sacrum, and long construct fixation with making contilever forces. Complications include: Failure of instrumentation, loss of sacral fixation and a high rate of nonunion. Methods: Twenty five patients with spinal diseases like spondylolisthesis, fracture, paralytic scoliosis, were operated with posterior fusion, CD instrumentation with sacral fixation (Chopin block, pedicular screw and iliosacral connector). Corrective angles like cobbʹs angle, pelvic angle, sacral inclination were measured before and after surgery (mean follow-up = 17 months). Influence of etiology, different sacral fixation methods, follow-up period, nonunion, corrective angles, ... were assessed in spite of loss of sacral fixation. Results: There is a significant correlation between sacral fixation failure and increasing age of patients at surgery (P=0.006), long follow-up period (P=0.023) and tulip screw type in pedicular screw system (P=0.03). Pseudoarthrosis at failure area is a significant cause of sacral fixation failure (P < 0.0001). Conclusion: There is not any significant difference between sacral fixation with CD instrumentation using Chopin block, iliosacral connector and pedicular screw in producing fixation failure. Other fixation methods like Luque Galvestone technique must be considered.