Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Rafael De la Garza Ramos, Jonathan Nakhla, Daniel M. Sciubba, Reza Yassari

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included-147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)-27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)-25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)-18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

Original languageEnglish (US)
Pages (from-to)253-258
Number of pages6
JournalJournal of neurosurgery. Spine
Volume30
Issue number2
DOIs
StatePublished - Nov 9 2018

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Meta-Analysis
Numbers Needed To Treat
Reoperation
Pain
Surgical Wound Infection
Wounds and Injuries
Wound Infection
PubMed
MEDLINE
daminozide
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Databases
Guidelines
Infection

Keywords

  • adult
  • ARR = absolute risk reduction
  • deformity
  • iliac screw
  • IS = iliac screw
  • meta-analysis
  • NASS = North American Spine Society
  • S2 alar-iliac screw
  • S2AI = S2 alar-iliac
  • sacral
  • spinopelvic

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Iliac screw versus S2 alar-iliac screw fixation in adults : a meta-analysis. / De la Garza Ramos, Rafael; Nakhla, Jonathan; Sciubba, Daniel M.; Yassari, Reza.

In: Journal of neurosurgery. Spine, Vol. 30, No. 2, 09.11.2018, p. 253-258.

Research output: Contribution to journalReview article

De la Garza Ramos, Rafael ; Nakhla, Jonathan ; Sciubba, Daniel M. ; Yassari, Reza. / Iliac screw versus S2 alar-iliac screw fixation in adults : a meta-analysis. In: Journal of neurosurgery. Spine. 2018 ; Vol. 30, No. 2. pp. 253-258.
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abstract = "OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included-147 in the IS group (45.5{\%}) and 176 in the S2AI group (54.5{\%}). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4{\%})-27.9{\%} in the IS group and 14.2{\%} in the S2AI group (13.7{\%} ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6{\%} (35/278)-25.4{\%} in the IS group and 2.6{\%} in the S2AI group (22.8{\%} ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8{\%})-18.1{\%} in the IS group and 1.8{\%} in the S2AI group (16.3{\%} ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.",
keywords = "adult, ARR = absolute risk reduction, deformity, iliac screw, IS = iliac screw, meta-analysis, NASS = North American Spine Society, S2 alar-iliac screw, S2AI = S2 alar-iliac, sacral, spinopelvic",
author = "{De la Garza Ramos}, Rafael and Jonathan Nakhla and Sciubba, {Daniel M.} and Reza Yassari",
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T1 - Iliac screw versus S2 alar-iliac screw fixation in adults

T2 - a meta-analysis

AU - De la Garza Ramos, Rafael

AU - Nakhla, Jonathan

AU - Sciubba, Daniel M.

AU - Yassari, Reza

PY - 2018/11/9

Y1 - 2018/11/9

N2 - OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included-147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)-27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)-25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)-18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

AB - OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included-147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)-27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)-25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)-18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

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KW - NASS = North American Spine Society

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KW - S2AI = S2 alar-iliac

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KW - spinopelvic

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