Efficacy and safety of lumbopelvic fixation in spinal metastasis comparing S2 Alar-iliac screw and conventional iliac screw

Abstract

Purpose: The clinical issue of lumbosacral metastases (LM) is really significant. This study aims to compare in patients with lumbar pathology (LM) the outcomes of the conventional iliac (CI) screw technique against the S2 alar-iliac (S2AI). Methods: A retrospective review of institutional databases was performed for lumbar metastasis patients. who underwent lumbopelvic fixation, with or without decompression, between April 2014 and April 2022. Demographic information, reoperation rates, operational time, estimated blood loss (EBL), and length of hospital stay (LOS) were collected. Patient-reported outcomes were the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EQ-5D-5L, which were examined both before and after surgery. Results: A total of 38 patients were involved in the study, with 21 allocated to the S2AI group and 17 to the CI group. The S2AI group demonstrated a length of stay (LOS) of 13.38 ± 8.35 days, in contrast to 24.35 ± 21.59 days, yielding a p-value of 0.047. The estimated blood loss in the S2AI group exhibited a decrease (592.86 ± 353.92 ml compared to 1073.53 ± 1122.45 ml; P = 0.137), alongside a reduction in operative time (181.19 ± 47.35 min versus 207.06 ± 105.69 min; variance = 0.648). Within the CI group, there were six patients who encountered surgical complications, accounting for 35.3%, while the S2AI group noted an absence of complications. The postoperative outcomes demonstrated a notable enhancement in both cohorts. Conclusions: Compared to CI, S2AI had better reoperation rates, estimated blood loss, operating duration, and length of stay. Both groups improved patient-reported outcomes, but the S2AI group improved significantly three months after surgery.