J Korean Soc Spine Surg.  2011 Sep;18(3):146-152.

The Effect of Sacral Alar Screw on Long-level Fusion Including Lumbosacral Segment

• Chung JY
• Seo HY
• Yim JH
• Kang KD
• Kim SK
• Lee GW

Abstract

STUDY DESIGN: This is a retrospective study.
OBJECTIVES
To evaluated the clinical and radiological effectiveness of sacral alar screws for augmentation of S1 pedicle screws in long-level fusion including L5-S1 segment. SUMMARY OF LITERATURE REVIEW: The fusion rates of lumbosacral junction in long-level fusion are various when S1 pedicle screws are used without augmentation. But, reports of sacral alar screw augmentation are rare. MATERIAL AND METHODS: From 1996 to 2005, 63 patients performed more than two-level fusion including lumbosacral junction were reviewed. 47 patients underwent lumbosacral fusion with S1 pedicle screws only (S1 group), and 16 patients with sacral alar screws augmentation in addition to S1 pedicle screws (S1-2 group). Radiologically, bony union, halo sign, and breakage of implants were evaluated. Clinically, complications associated with screw placement and general complications were evaluated.
RESULTS
Bony union was obtained in 56 cases(89%) at postoperative 4.3 months. Nonunion was observed in 7 cases(11%, S1 group:5, S1-2 group:2). Loosening of S1 pedicle screw was observed in 32 cases(89%) of S1 group and in 4 cases(25%) of S1-2 group. It showed statistical significance between two groups. Sacral alar screw loosening occurred in 8 cases(50%) of S1-2 group. Metal breakage was developed in 2 cases of S1 group without nonunion or loosening. Postoperative infection occurred in 7 cases(11%, S1 group:5, S1-2 group:2).
CONCLUSIONS
Sacral alar screw augmentation was effective on protecting the loosening of S1 pedicle screw. Additional sacral alar screw can improve the rate of fusion for lumbosacral junction despite no statistical significance.

Keyword

Lumbosacral fusion; Long level fusion; Sacral alar screw augmentation

MeSH Terms

Humans
Retrospective Studies
Succinates
Succinates

Figure

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  Fig 1. (A, B) Preoperative anteroposterio(AP) and lateral views of a 59 year-old female show degenerative spondylolisthesis, L3-4 and narrowing of L4-5-S1 disc spaces. (C, D) 2 years followup AP and lateral views fixed with S1 pedicle sacral screw and augmentation with sacral alar screw show solid union and no evidence of metal failure.

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  Fig 2. (A, B)Preoperative AP and lateral views of a 53 year-old female show isthmic spondylolisthesis L3-S1. (C, D) 5 years 10months followup anteroposterior and lateral views fixed with single sacral screw show union of posterolateral fusion but breakages of one sacral screw and one opposite rod.

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