Gómez-Rice Alejandro, Núñez-Pereira Susana, Haddad Sleiman, Raganato Riccardo, Charles Yann Philippe, Pérez-Grueso Franciso, Kleinstück Frank, Obeid Ibrahim, Alanay Ahmet, Pellise Ferran, Pizones Javier
Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9.100., 28034, Madrid, Spain.
ESSG. European Spine Study Group, Barcelona, Spain.
Eur J Orthop Surg Traumatol. 2025 Mar 9;35(1):104. doi: 10.1007/s00590-025-04215-6.
The purpose of this study was to compare the S2-alar-iliac (S2AI) technique with the iliac screw (IS) technique in adult spinal deformity (ASD) patients in terms of clinical and radiographical outcomes, focusing on reoperations, complications, and change in radiographic parameters.
This is a retrospective review of a prospective, multicenter database. ASD patients who underwent long fusion to the pelvis with 2-year postoperative follow-up were included. To compare outcomes (radiographic, clinical, and complications), matching was performed based on the type of pelvic fixation (IS vs. S2AI) using propensity score matching (PSM), 1:1 ratio, caliper 0.1, tolerance ≤ 0.001, with a 95% confidence interval. Kaplan-Meier survival curves were generated for each group and compared between the two groups by the log-rank test. Hazard ratio (HR) was calculated using the Cox proportional hazards model.
Out of 1442 patients undergoing intervention with a 2-year follow-up, 555 were identified as having pelvic instrumentation. Among them, 52 patients fixed with S2AI screws were matched with 52 patients fixed with IS using PSM for age, body mass index (BMI), number of fused levels, and global tilt. No significant differences were found in radiographic correction, reoperation rates, or infection rates. The percentage of mechanical complications (MC) was higher in the IS screw group, with a statistically significant increase in MC-free survival in the S2AI screw group (80.6 vs. 61.2 months; p = 0.022), with a HR of 0.43 (p = 0.027). Patients with S2AI screws reported higher immediate postoperative pain at 6 weeks, with this difference leveling off in subsequent assessments. At 2 years, a higher percentage of radiolucent halos were observed in the S2AI screw group (59.6% vs. 34%; p = 0.017), but there were no differences in pain assessments in the quality-of-life tests.
After a thorough comparison, both pelvic fixation methods showed similar deformity correction and reintervention rates. However, iliac screws had more mechanical complications, while S2AI screws, crossing the sacroiliac joint, led to higher short-term postoperative pain and increased radiological loosening at 2 years.
本研究旨在比较成人脊柱畸形（ASD）患者中S2-翼-髂骨（S2AI）技术与髂骨螺钉（IS）技术在临床和影像学结果方面的差异，重点关注再次手术、并发症以及影像学参数的变化。
这是一项对前瞻性多中心数据库的回顾性研究。纳入接受骨盆长节段融合且术后随访2年的ASD患者。为比较结果（影像学、临床和并发症），采用倾向得分匹配（PSM），以1:1的比例、卡尺0.1、容许度≤0.001、95%置信区间，根据骨盆固定类型（IS与S2AI）进行匹配。为每组生成Kaplan-Meier生存曲线，并通过对数秩检验在两组之间进行比较。使用Cox比例风险模型计算风险比（HR）。
在1442例接受干预并随访2年的患者中，555例被确定进行了骨盆内固定。其中，52例使用S2AI螺钉固定的患者与52例使用IS固定的患者在年龄、体重指数（BMI）、融合节段数和整体倾斜度方面进行了PSM匹配。在影像学矫正、再次手术率或感染率方面未发现显著差异。IS螺钉组的机械并发症（MC）百分比更高，S2AI螺钉组的无MC生存期有统计学显著增加（80.6个月对61.2个月；p = 0.022），HR为0.43（p = 0.027）。使用S2AI螺钉的患者术后6周报告的即时疼痛更高，在随后的评估中这种差异逐渐减小。在2年时，S2AI螺钉组观察到更高比例的透亮晕（59.6%对34%；p = 0.017），但在生活质量测试中的疼痛评估没有差异。
经过全面比较，两种骨盆固定方法在畸形矫正和再次干预率方面表现相似。然而，髂骨螺钉有更多的机械并发症，而穿过骶髂关节的S2AI螺钉导致术后短期疼痛更高，且在2年时放射学松动增加。
