Funayama Toru, Yanagisawa Yohei, Ogata Yosuke, Okuwaki Shun, Tatsumura Masaki
Orthopaedic Surgery, University of Tsukuba, Tsukuba, JPN.
Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, JPN.
Cureus. 2024 Nov 13;16(11):e73638. doi: 10.7759/cureus.73638. eCollection 2024 Nov.
Although neurovascular structures, including the superior gluteal artery, sciatic nerve, obturator nerve, internal iliac vein and artery, and lumbosacral plexus, are at risk when S2 alar-iliac (S2AI) screws are used, no cases of nerve injuries have been reported. An 84-year-old man was referred to our institute with persistent left sciatica for seven months after undergoing salvage surgery using S2AI screws for deep surgical site infection from a previous posterior interbody fusion surgery at L5-S1. Based on the radiographic and diagnostic selective nerve root block findings, a diagnosis of left L5 radiculopathy was suspected due to the left S2AI screw being caudally misplaced and severely protruding into the pelvic cavity. The patient underwent surgical replacement of the left S2AI screw. The patient was discharged eight days postoperatively, with a resolution of the left leg pain. At the three-month follow-up, no recurrent pain was reported. To the best of our knowledge, this is the first reported case of a misplaced S2AI screw causing L5 spinal nerve injury. If the screw is inserted caudally and deviates into the pelvic cavity, in front of the sacroiliac joint, the L5 nerve running in this region may be damaged.
尽管在使用S2翼髂（S2AI）螺钉时，包括臀上动脉、坐骨神经、闭孔神经、髂内动静脉和腰骶丛在内的神经血管结构存在风险，但尚未有神经损伤的病例报道。一名84岁男性因之前L5-S1后路椎间融合手术深部手术部位感染，在接受使用S2AI螺钉的挽救手术后持续左下肢坐骨神经痛7个月，被转诊至我院。根据影像学和诊断性选择性神经根阻滞结果，怀疑因左S2AI螺钉尾侧移位并严重突入盆腔导致左侧L5神经根病。患者接受了左S2AI螺钉的手术置换。患者术后8天出院，左腿疼痛缓解。在3个月的随访中，未报告复发性疼痛。据我们所知，这是首例关于错位的S2AI螺钉导致L5脊神经损伤的报道病例。如果螺钉向尾侧插入并在骶髂关节前方偏离进入盆腔，在此区域走行的L5神经可能会受损。
