Clinical Application Of The Second Sacral Alar-iliac Fixation Technique In The Adult Degenerative Lumbar Lateral Kyphosis Complicated With Osteoporosis

ObjectiveTo investigate the efficacy of the second sacroiliac screw fixation(S2AI)in the treatment of adult patients with degenerative lumbar lateral kyphosis with Osteoporosis(OP),the maintenance of the effect and the complications after postoperative follow-up.To provide a reference for the selection of the best surgical plan.MethodsAccording to the inclusion and exclusion criteria,data of 40 adult patients with lumbar lateral kyphosis complicated with OP admitted to the Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University from January 2016 to September 2020 were collected and divided into two groups according to different surgical methods.Among them,20 patients were in S2AI group,all of which were fixed to the sacral 2 level,including 4 males and 16 females.There were 20 patients in the sacral 1 level(S1)group,including 3 males and 17 females.Patients’ general information including the age,operation time,blood loss,the follow-up time,all patients were measured preoperative and postoperative follow-up and side convex spine-pelvic parameters,including Cobb angle of scoliosis,sagittal vertical axis(SVA),C7 plumb line-center sacral vertical line(C7PL-CSVL),pelvic obiquity and regional kyphosis(RK)Cobb Angle.All imaging data of the two groups of patients were retrospectively compared.The basic data,the difference of spine-pelvis parameters before,after and during the follow-up period and the postoperative efficacy of the two groups were compared.ResultsThere were no statistically significant differences in age,operation duration,blood loss,or follow-up time between the two groups.In S2AI group,before operation Cobb Angle37.4°±7.3°,C7PL-CSVL13.6±5.1mm,Pelvic tilt5.0°±1.9°,RKCobb Angle41.6°±21.6° and SVA34.5mm±20.1mm.Cobb Angle 18.0°±7.0°,C7PL-CSVL6.0±1.8mm,Pelvic tilt2.1°±1.0°,RKCobb Angle3.6°±17.4° and SVA16.9mm±14.1mm were significantly corrected in the last follow-up,and the differences were statistically significant(P<0.05).The above measured values were not statistically significant(P>0.05),There was no change or loss of Motor evoked potential(MEP)and Somatosensory evoked potential(SSEP)signals in all patients during operation.In S1 group,1 case of S1 screw screw breakage revision surgery,and 1 case PJK,7 cases with lumbar di ministry pain,the treatment of symptoms,No screw loosening occurred in S2AI group,and 2 cases had delayed hip pain,which was relieved after treatment.Conclusion1.The application of S2AI screw technology in patients with degenerative lumbar kyphosis complicated with OP can effectively improve the coronal plane and sagittal plane imbalance of lumbar kyphosis deformity,improve pain,restore the physiological curvature of the lumbar and correct the pelvic tilt.2.Distal fixation to S2 can obtain expected spine deformity correction and balance,while satisfactory corrective effect,ensure the strength of fixed,orthopaedic loss and the rate of complications,improve the patient’s quality of life,for lumbar degenerative deformity OP combined type of surgery is good.