Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-Galveston, combined iliac and sacral screws, and sacral fixation

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2002-04, Vol.27 (7), p.776-786
• Main Authors: EMAMI, Arash, DEVIREN, Vedat, BERVEN, Sigurd, SMITH, Jason A, HU, Serena S, BRADFORD, David S
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bone Nails; Bone Screws; Bone Wires; Diseases of the osteoarticular system; Diseases of the spine; Female; Humans; Ilium - surgery; Lumbar Vertebrae - surgery; Male; Medical sciences; Middle Aged; Radiography; Retrospective Studies; Sacrum - surgery; Spinal Curvatures - diagnostic imaging; Spinal Curvatures - surgery; Spinal Fusion - adverse effects; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/00007632-200204010-00017

A retrospective study of adults with long fusion to the sacrum using three different fixations was performed. To compare the long-term clinical results and complications associated with three methods of lumbosacral fixation for adult spine deformities: Luque-Galveston, combined iliac and sacral screws, and sacral screws. The preferred technique for long fusion to the sacrum is controversial, and surgery for adult deformity is fraught with significant technical difficulties and high complication rates. No clinical study compares the long-term outcome of long fusion to the sacrum using these different methods of lumbosacral fixation. This study included 54 consecutive patients who underwent elective combined anterior and posterior surgical reconstruction for adult spine deformity with a minimum follow-up period of 2 years. The patients were divided into three groups on the basis of the surgical method used for the posterior spine instrumentation. Group 1 consisted of 11 patients with smooth L-rod and segmental sublaminar wire instrumentation (Luque-Galveston technique). Group 2 consisted of 36 patients with posterior Isola segmental instrumentation and combined iliac and sacral screws. Group 3 consisted of 12 patients with Isola segmental instrumentation using bicortical sacral screws. Five patients were revised to another fixation group, giving a total of 59 cases. Radiographic, clinical results, and long-term outcome data were obtained using the modified Scoliosis Research Society (SRS) outcome instrument. There were 26 late complications. Pseudarthrosis developed in 10 patients, requiring revision surgery: 4 (36%) in the Group 1, 5 (14%) in Group 2, and 1 (8.5%) in Group 3. Comparison of the modified SRS outcomes showed no difference among the groups. The average SRS grand total score was 73.4% for Group 1, 70.9% for Group 2, and 62.6% for Group 3. Overall, 76% of the patients were satisfied with their outcome. The presence of perioperative complications or pseudarthrosis significantly correlated with a lower satisfaction score (P = 0.012 and P = 0.048, respectively). Sagittal plane decompensation significantly correlated with a higher pain score (P = 0.035). Patients with prior surgeries scored lower on the self-image questions than patients with no prior surgery (P = 0.007). Attention to sagittal balance is critical in these patients. Revision surgery is as safe and effective as primary surgery. According to the current findings, the Luque-Galveston fix