Choi Ho Yong, Jo Dae Jean
Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Neurosurgery, College of Medicine, Kangwon National University, Chuncheon, Korea.
Neurospine. 2021 Sep;18(3):554-561. doi: 10.14245/ns.2142148.074. Epub 2021 Sep 30.
To compare the outcomes of S1 foraminal hooks and iliac screws regarding fusion rate at the lumbosacral junction and protective effects on S1 screws.
From January 2017 to December 2019, consecutive patients who underwent long fusions (uppermost instrumented vertebra at or above L1) to the sacrum for adult spinal deformity were enrolled. Patients were divided into S1 foraminal hook group and iliac screw group. Radiographic parameters and the incidence of pseudarthrosis and instrument failure at the lumbosacral junction were compared between the groups.
Twenty-nine patients (male:female = 1:28) with a mean age of 73.6 ± 6.8 years were evaluated. Sixteen patients (55.2%) had S1 foraminal hook fixation and 13 patients (44.8%) had iliac screw fixation. Lumbar lordosis, sacral slope, and sagittal vertical axis did not differ between the groups preoperatively and postoperatively. The rate of L5/S1 pseudarthrosis was significantly higher in S1 foraminal hook group (5 of 16, 31.3%), compared to iliac screw group (0 of 13, 0%; p = 0.048). Instrument failure at the lumbosacral junction trended toward a higher rate in S1 foraminal hook group (6 of 16, 37.5%) than in iliac screw group (1 of 13, 7.7%), without statistical significance (p = 0.09). Proximal junctional kyphosis/failure occurred less often in S1 foraminal hook group (2 of 16, 12.5%) than in iliac screw group (3 of 13, 30.8%) without statistical significance (p = 0.36).
Treatment with S1 foraminal hooks achieved equivalent satisfactory sagittal correction with proportioned alignment compared to that with iliac screws. However, S1 foraminal hooks did not provide enough structural support to the lumbosacral junction in long fusions to the sacrum.
比较S1椎间孔钩和髂骨螺钉在腰骶部融合率以及对S1螺钉的保护作用方面的疗效。
纳入2017年1月至2019年12月期间因成人脊柱畸形接受长节段融合术（最上端固定椎体在L1或L1以上）至骶骨的连续患者。患者分为S1椎间孔钩组和髂骨螺钉组。比较两组之间的影像学参数、腰骶部假关节发生率和器械失败率。
共评估了29例患者（男:女 = 1:28），平均年龄73.6±6.8岁。16例患者（55.2%）采用S1椎间孔钩固定，13例患者（44.8%）采用髂骨螺钉固定。两组术前和术后的腰椎前凸、骶骨倾斜度和矢状垂直轴无差异。S1椎间孔钩组L5/S1假关节发生率显著高于髂骨螺钉组（16例中的5例，31.3% vs. 13例中的0例，0%；p = 0.048）。S1椎间孔钩组腰骶部器械失败率有高于髂骨螺钉组的趋势（16例中的6例，37.5% vs. 13例中的1例，7.7%），但无统计学意义（p = 0.09）。S1椎间孔钩组近端交界性后凸/失败发生率低于髂骨螺钉组（16例中的2例，12.5% vs. 13例中的3例，30.8%），无统计学意义（p = 0.36）。
与髂骨螺钉相比，S1椎间孔钩治疗在矢状面矫正和对线比例方面取得了同等满意的效果。然而，在长节段融合至骶骨时，S1椎间孔钩对腰骶部的结构支撑不足。
