Rafael Garcia, Kari Odland, Paul Lender, David Polly
{"title":"S2AI and iliac screw prominence and removal for symptomatic prominence: a systematic review.","authors":"Rafael Garcia, Kari Odland, Paul Lender, David Polly","doi":"10.1007/s00586-025-08714-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Sacropelvic fixation plays a crucial role in complex spinal surgeries, particularly in adult spinal deformity (ASD) and other conditions requiring lumbosacral stabilization. This systematic review and meta-analysis aims to compare the rates of symptomatic screw prominence and screw removal between S2-alar-iliac (S2AI) and iliac screws, as well as those examining each screw type independently, to provide a comprehensive understanding and guide surgical decision-making and improve patient outcomes.</p><p><strong>Methods: </strong>A systematic review following PRISMA guidelines was conducted using Medline, SPORTDiscus, Cochrane Library, and Scopus databases. Inclusion criteria encompassed studies evaluating screw prominence or removal rates for S2AI and iliac screws, individually or in comparison, involving adult patients with sacropelvic fixation. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted. Statistical analysis included relative risk difference (RR) calculations using a random effects model, with heterogeneity assessed via the I² statistic.</p><p><strong>Results: </strong>Eighteen studies were included, comprising 1462 patients: 648 with S2AI screws and 814 with iliac screws. Symptomatic screw prominence was significantly lower for S2AI screws (1.9%, 12/648) compared to iliac screws (6.3%, 51/814), with a pooled RR difference of 0.08 (95% CI 0.04, p < 0.001). Screw removal rates due to prominence were 0% (0/12) for S2AI screws versus 27.5% (14/51) for iliac screws. Low heterogeneity was observed for both outcomes (I² = 3.32% for prominence, I² = 0.0% for removal).</p><p><strong>Conclusion: </strong>S2AI screws demonstrate significantly lower rates of symptomatic prominence and screw removal compared to iliac screws, supporting their clinical and economic advantages in sacropelvic fixation for ASD. Technological advancements and innovations in implant design further enhance the efficacy of S2AI screws. These findings advocate for their adoption as an effective fixation technique, reducing hardware complications and improving patient outcomes. Future studies will aim to explore factors influencing prominence risk and optimize surgical strategies in ASD treatment.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"1398-1408"},"PeriodicalIF":2.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-025-08714-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/8 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Sacropelvic fixation plays a crucial role in complex spinal surgeries, particularly in adult spinal deformity (ASD) and other conditions requiring lumbosacral stabilization. This systematic review and meta-analysis aims to compare the rates of symptomatic screw prominence and screw removal between S2-alar-iliac (S2AI) and iliac screws, as well as those examining each screw type independently, to provide a comprehensive understanding and guide surgical decision-making and improve patient outcomes.
Methods: A systematic review following PRISMA guidelines was conducted using Medline, SPORTDiscus, Cochrane Library, and Scopus databases. Inclusion criteria encompassed studies evaluating screw prominence or removal rates for S2AI and iliac screws, individually or in comparison, involving adult patients with sacropelvic fixation. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted. Statistical analysis included relative risk difference (RR) calculations using a random effects model, with heterogeneity assessed via the I² statistic.
Results: Eighteen studies were included, comprising 1462 patients: 648 with S2AI screws and 814 with iliac screws. Symptomatic screw prominence was significantly lower for S2AI screws (1.9%, 12/648) compared to iliac screws (6.3%, 51/814), with a pooled RR difference of 0.08 (95% CI 0.04, p < 0.001). Screw removal rates due to prominence were 0% (0/12) for S2AI screws versus 27.5% (14/51) for iliac screws. Low heterogeneity was observed for both outcomes (I² = 3.32% for prominence, I² = 0.0% for removal).
Conclusion: S2AI screws demonstrate significantly lower rates of symptomatic prominence and screw removal compared to iliac screws, supporting their clinical and economic advantages in sacropelvic fixation for ASD. Technological advancements and innovations in implant design further enhance the efficacy of S2AI screws. These findings advocate for their adoption as an effective fixation technique, reducing hardware complications and improving patient outcomes. Future studies will aim to explore factors influencing prominence risk and optimize surgical strategies in ASD treatment.
期刊介绍：
"European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts.
Official publication of EUROSPINE, The Spine Society of Europe
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