Minimally invasive sacroiliac fixation in oncologic patients with sacral insufficiency fractures using a fluoroscopy-based navigation system

Ioannis D. Papanastassiou, Matthias Setzer, Mohammad Eleraky, Mhd-Ali - Baaj, Tran Nam, Odion Binitie, Kiesha Katsares, David Cheong, Frank D. Vrionis

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

STUDY DESIGN: Surgical technique article with retrospective case series. SUMMARY OF BACKGROUND DATA: Sacral insufficiency fractures are commonly encountered in oncologic patients and constitute a cause for persistent lower back and pelvic pain. OBJECTIVE: The aim of this study is to describe the modified technique of navigated percutaneous sacroiliac (SI) fixation using multiple long screws per level that cross both SI joints and engage bilateral iliac bones; furthermore to evaluate its safety and efficacy in oncologic patients with sacral insufficiency fractures. METHODS: Six oncologic patients (3 male, 3 female, mean age: 58.8 y) with sacral insufficiency fractures who had undergone additional radiation therapy were operated with navigated percutaneous fixation. Two patients had failed preoperative sacroplasty and 1 had failed SI pinning. Eighteen SI screws were placed (15 at S1 level and 3 at S2). In the majority of cases the screws were long enough to engage bilateral ilium and sacrum. Additionally, 1 patient underwent percutaneous iliolumbar instrumentation and in 4 patients we performed concomitant sacroplasty or polymethylmethacrylate screw augmentation. The patients were followed for 18.8 months in average (range: 12-30 mo). Outcome was assessed using the Karnofsky Performance Status score (KPS), pain scale (0-10) and detailed neurologic examination. RESULTS: In 1 case, a revision of a screw was required due to radiculopathy. There was no perioperative morbidity or mortality. No hardware failure was encountered. There was significant improvement in KPS (P=0.04) and pain levels (P=0.02). CONCLUSIONS: These preliminary data suggest that navigated percutaneous SI screw fixation is a safe and effective intervention in terms of pain control and performance status improvement in oncologic patients with sacral insufficiency fractures. For optimal fixation, multiple long screws that engage both iliac bones may be inserted through the S1 level in a safe manner. The technique may be combined with sacroplasty or closed posterior instrumentation to augment the screw fixation. Further investigation is needed to compare this technique with other treatment modalities.

Original languageEnglish (US)
Pages (from-to)76-82
Number of pages7
JournalJournal of Spinal Disorders and Techniques
Volume24
Issue number2
DOIs
StatePublished - Apr 2011
Externally publishedYes

Fingerprint

Stress Fractures
Fluoroscopy
Karnofsky Performance Status
Pain
Ilium
Sacroiliac Joint
Bone and Bones
Sacrum
Radiculopathy
Pelvic Pain
Neurologic Examination
Polymethyl Methacrylate
Low Back Pain
Radiotherapy
Morbidity
Safety
Mortality

Keywords

  • navigation
  • sacral insufficiency fractures
  • sacral tumors
  • sacroiliac screws

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Minimally invasive sacroiliac fixation in oncologic patients with sacral insufficiency fractures using a fluoroscopy-based navigation system. / Papanastassiou, Ioannis D.; Setzer, Matthias; Eleraky, Mohammad; Baaj, Mhd-Ali -; Nam, Tran; Binitie, Odion; Katsares, Kiesha; Cheong, David; Vrionis, Frank D.

In: Journal of Spinal Disorders and Techniques, Vol. 24, No. 2, 04.2011, p. 76-82.

Research output: Contribution to journalArticle

Papanastassiou, Ioannis D. ; Setzer, Matthias ; Eleraky, Mohammad ; Baaj, Mhd-Ali - ; Nam, Tran ; Binitie, Odion ; Katsares, Kiesha ; Cheong, David ; Vrionis, Frank D. / Minimally invasive sacroiliac fixation in oncologic patients with sacral insufficiency fractures using a fluoroscopy-based navigation system. In: Journal of Spinal Disorders and Techniques. 2011 ; Vol. 24, No. 2. pp. 76-82.
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AU - Setzer, Matthias

AU - Eleraky, Mohammad

AU - Baaj, Mhd-Ali -

AU - Nam, Tran

AU - Binitie, Odion

AU - Katsares, Kiesha

AU - Cheong, David

AU - Vrionis, Frank D.

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N2 - STUDY DESIGN: Surgical technique article with retrospective case series. SUMMARY OF BACKGROUND DATA: Sacral insufficiency fractures are commonly encountered in oncologic patients and constitute a cause for persistent lower back and pelvic pain. OBJECTIVE: The aim of this study is to describe the modified technique of navigated percutaneous sacroiliac (SI) fixation using multiple long screws per level that cross both SI joints and engage bilateral iliac bones; furthermore to evaluate its safety and efficacy in oncologic patients with sacral insufficiency fractures. METHODS: Six oncologic patients (3 male, 3 female, mean age: 58.8 y) with sacral insufficiency fractures who had undergone additional radiation therapy were operated with navigated percutaneous fixation. Two patients had failed preoperative sacroplasty and 1 had failed SI pinning. Eighteen SI screws were placed (15 at S1 level and 3 at S2). In the majority of cases the screws were long enough to engage bilateral ilium and sacrum. Additionally, 1 patient underwent percutaneous iliolumbar instrumentation and in 4 patients we performed concomitant sacroplasty or polymethylmethacrylate screw augmentation. The patients were followed for 18.8 months in average (range: 12-30 mo). Outcome was assessed using the Karnofsky Performance Status score (KPS), pain scale (0-10) and detailed neurologic examination. RESULTS: In 1 case, a revision of a screw was required due to radiculopathy. There was no perioperative morbidity or mortality. No hardware failure was encountered. There was significant improvement in KPS (P=0.04) and pain levels (P=0.02). CONCLUSIONS: These preliminary data suggest that navigated percutaneous SI screw fixation is a safe and effective intervention in terms of pain control and performance status improvement in oncologic patients with sacral insufficiency fractures. For optimal fixation, multiple long screws that engage both iliac bones may be inserted through the S1 level in a safe manner. The technique may be combined with sacroplasty or closed posterior instrumentation to augment the screw fixation. Further investigation is needed to compare this technique with other treatment modalities.

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