Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis

Haruki Funao, Khaled M. Kebaish, Norihiro Isogai, Takahiro Koyanagi, Morio Matsumoto, Ken Ishii

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique. Case Description Case 1 is a 77-year-old man who presented with low back pain and high fever. He was diagnosed with spondylodiscitis at L4-5. He had a history of lung cancer, which was complicated by the recurrence. Because nonsurgical treatment failed, MISt with percutaneous S2AI screws was performed. The patient's low back pain subsided markedly 1 week after surgery, and there was no screw/rod breakage or recurrence of infection during the follow-up period. Case 2 is a 71-year-old man who presented with hemiparesis because of a stroke. He also developed high fever and was diagnosed with spondylodiscitis at L5-S1. Because nonsurgical treatment failed, the patient was treated by MISt with percutaneous S2AI screws while being maintained on anticoagulants for stroke. Although his clinical symptoms had markedly improved, a postoperative lumbar computed tomography scan demonstrated a bone defect at L5-S1. An anterior spinal fusion with an iliac bone graft at L5-S1 was performed when a temporary cessation of anticoagulants was permitted. Both patients tolerated the procedures well and had no major perioperative complications. Conclusions MISt with percutaneous S2AI screws was less invasive and efficacious for lumbosacral spondylodiscitis in providing rigid percutaneous sacropelvic fixation.

Original languageEnglish
Pages (from-to)757.e11-757.e18
JournalWorld Neurosurgery
Volume97
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Discitis
Immunocompromised Host
Spine
Low Back Pain
Anticoagulants
Fever
Stroke
Bone and Bones
Recurrence
Spinal Fusion
Paresis
Lung Neoplasms
Therapeutics
Tomography
daminozide
Transplants
Infection

Keywords

  • Iliac screw
  • Minimally invasive spine stabilization
  • Percutaneous S2-alar-iliac screw
  • S2-alar-iliac screw
  • Sacropelvic fixation
  • Spondylodiscitis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis. / Funao, Haruki; Kebaish, Khaled M.; Isogai, Norihiro; Koyanagi, Takahiro; Matsumoto, Morio; Ishii, Ken.

In: World Neurosurgery, Vol. 97, 01.01.2017, p. 757.e11-757.e18.

Research output: Contribution to journalArticle

Funao, Haruki ; Kebaish, Khaled M. ; Isogai, Norihiro ; Koyanagi, Takahiro ; Matsumoto, Morio ; Ishii, Ken. / Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis. In: World Neurosurgery. 2017 ; Vol. 97. pp. 757.e11-757.e18.
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AB - Background Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique. Case Description Case 1 is a 77-year-old man who presented with low back pain and high fever. He was diagnosed with spondylodiscitis at L4-5. He had a history of lung cancer, which was complicated by the recurrence. Because nonsurgical treatment failed, MISt with percutaneous S2AI screws was performed. The patient's low back pain subsided markedly 1 week after surgery, and there was no screw/rod breakage or recurrence of infection during the follow-up period. Case 2 is a 71-year-old man who presented with hemiparesis because of a stroke. He also developed high fever and was diagnosed with spondylodiscitis at L5-S1. Because nonsurgical treatment failed, the patient was treated by MISt with percutaneous S2AI screws while being maintained on anticoagulants for stroke. Although his clinical symptoms had markedly improved, a postoperative lumbar computed tomography scan demonstrated a bone defect at L5-S1. An anterior spinal fusion with an iliac bone graft at L5-S1 was performed when a temporary cessation of anticoagulants was permitted. Both patients tolerated the procedures well and had no major perioperative complications. Conclusions MISt with percutaneous S2AI screws was less invasive and efficacious for lumbosacral spondylodiscitis in providing rigid percutaneous sacropelvic fixation.

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