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A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion

BACKGROUND: Sacral fractures and failures are uncommon after lumbosacral fusion but have received increasing attention in the surgical literature. They can be difficult to diagnose, making timely treatment difficult. No consensus has been reached on the characteristics of these complications or on o...

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Autores principales: Weinreb, Jeffrey H., Iweala, Uchechi, Matteini, Lauren E., Yu, Warren D., O’Brien, Joseph R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253560/
https://www.ncbi.nlm.nih.gov/pubmed/32518533
http://dx.doi.org/10.1007/s11420-019-09706-x
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author Weinreb, Jeffrey H.
Iweala, Uchechi
Matteini, Lauren E.
Yu, Warren D.
O’Brien, Joseph R.
author_facet Weinreb, Jeffrey H.
Iweala, Uchechi
Matteini, Lauren E.
Yu, Warren D.
O’Brien, Joseph R.
author_sort Weinreb, Jeffrey H.
collection PubMed
description BACKGROUND: Sacral fractures and failures are uncommon after lumbosacral fusion but have received increasing attention in the surgical literature. They can be difficult to diagnose, making timely treatment difficult. No consensus has been reached on the characteristics of these complications or on optimal treatment. QUESTIONS/PURPOSES: The goal of this retrospective case series is to contribute additional cases of these uncommon complications of lumbosacral fusion to the surgical literature to help clinicians to anticipate, diagnose, characterize, manage, and treat sacral fractures and failures after lumbosacral fusion. METHODS: The medical records of five patients who experienced a sacral fracture or failure after lumbosacral fusion between January 2012 and November 2017 were identified and reviewed retrospectively. Records were reviewed for age, sex, clinical presentation, previous management, outpatient clinical records, imaging, and post-operative course. RESULTS: Four patients in the series experienced a sacral fracture and one experienced hardware failure. All patients presented with elevated pain and underwent revision surgery. Radiographic detection of the fracture or failure occurred at a mean of 11.2 weeks (range, 3 to 24 weeks) after initial surgery, and the mean age of patients was 68.2 years (range, 63 to 80 years). Of the five patients, four were female; two had been diagnosed with osteoporosis and two with osteopenia. In our case series, the S2–alar–iliac (S2AI) technique was used with success in all five cases. CONCLUSION: Fractures and failures after lumbosacral fusion can be difficult to diagnose because of delayed presentation, nonspecific presenting symptoms, and a lack of identifiable mechanism. A high index of suspicion is required to detect these uncommon complications, and patients have responded well to both conservative and surgical treatments.
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spelling pubmed-72535602020-06-08 A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion Weinreb, Jeffrey H. Iweala, Uchechi Matteini, Lauren E. Yu, Warren D. O’Brien, Joseph R. HSS J Original Article BACKGROUND: Sacral fractures and failures are uncommon after lumbosacral fusion but have received increasing attention in the surgical literature. They can be difficult to diagnose, making timely treatment difficult. No consensus has been reached on the characteristics of these complications or on optimal treatment. QUESTIONS/PURPOSES: The goal of this retrospective case series is to contribute additional cases of these uncommon complications of lumbosacral fusion to the surgical literature to help clinicians to anticipate, diagnose, characterize, manage, and treat sacral fractures and failures after lumbosacral fusion. METHODS: The medical records of five patients who experienced a sacral fracture or failure after lumbosacral fusion between January 2012 and November 2017 were identified and reviewed retrospectively. Records were reviewed for age, sex, clinical presentation, previous management, outpatient clinical records, imaging, and post-operative course. RESULTS: Four patients in the series experienced a sacral fracture and one experienced hardware failure. All patients presented with elevated pain and underwent revision surgery. Radiographic detection of the fracture or failure occurred at a mean of 11.2 weeks (range, 3 to 24 weeks) after initial surgery, and the mean age of patients was 68.2 years (range, 63 to 80 years). Of the five patients, four were female; two had been diagnosed with osteoporosis and two with osteopenia. In our case series, the S2–alar–iliac (S2AI) technique was used with success in all five cases. CONCLUSION: Fractures and failures after lumbosacral fusion can be difficult to diagnose because of delayed presentation, nonspecific presenting symptoms, and a lack of identifiable mechanism. A high index of suspicion is required to detect these uncommon complications, and patients have responded well to both conservative and surgical treatments. Springer US 2019-07-29 2020-07 /pmc/articles/PMC7253560/ /pubmed/32518533 http://dx.doi.org/10.1007/s11420-019-09706-x Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Weinreb, Jeffrey H.
Iweala, Uchechi
Matteini, Lauren E.
Yu, Warren D.
O’Brien, Joseph R.
A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion
title A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion
title_full A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion
title_fullStr A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion
title_full_unstemmed A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion
title_short A Case Series That Supports the Application of the S2AI Technique for Fractures and Failures After Lumbosacral Fusion
title_sort case series that supports the application of the s2ai technique for fractures and failures after lumbosacral fusion
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253560/
https://www.ncbi.nlm.nih.gov/pubmed/32518533
http://dx.doi.org/10.1007/s11420-019-09706-x
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