Intrasacral rod fixation for pediatric long spinal fusion: results of a prospective study with a minimum 5-year follow-up.
BACKGROUND
Lumbosacral fusion is often needed in cases of pediatric neuromuscular spinal deformities. Despite the numerous fixation techniques described, the procedure remains challenging. Jackson has described a method of intrasacral fixation providing immediate 3-dimensional stability and promising clinical results. The purpose of this study was to report our experience with long spinal fusion using Jackson intrasacral fixation in pediatric patients.


METHODS
All patients with at least 5 years of follow-up were reviewed. No brace was used postoperatively. Clinical data and radiographs were collected and analyzed preoperatively, postoperatively, and at latest follow-up. Intraoperative and postoperative complications were reported. Paired t test was used for statistical analysis.


RESULTS
Fifty-six patients were included. The average age at surgery was 15.3 years. Mean follow-up period was 10.3 years and no patient was lost to follow-up. All radiographic parameters (frontal balance, frontal Cobb angle of the primary curve, iliolumbar angle, pelvic obliquity, sagittal balance, lumbosacral lordosis, and sacral slope) were significantly improved postoperatively (P<0.001), without significant loss of correction at latest follow-up. Four early infections, 1 pressure sore, and 4 cases of radicular pain, which resolved without intervention, were reported postoperatively. At latest follow-up, no patient complained of lumbar pain, and neither ambulatory status nor activity level ability worsened in any case. Sixteen of the 20 patients who needed a sitting orthosis preoperatively achieved a functional sitting posture without bracing.


CONCLUSIONS
Jackson fixation is a safe and reliable technique providing immediate stability. In our series, no mechanical complication occurred and no loss of correction was observed, despite immediate unprotected mobilization. The method provides reliable good sacral fixation for pediatric neuromuscular spinal deformities, especially when the correction of severe pelvic obliquity is necessary.


METHODS
This consecutive series provides level IV evidence.
Ilharreborde
Brice
B
Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris 7 University, Paris. i_brice@hotmail.com
Hoffmann
Etienne
E
Tavakoli
Said
S
Queinnec
Steffen
S
Fitoussi
Franck
F
Presedo
Ana
A
Penneçot
Georges-François
GF
Mazda
Keyvan
K
D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009468:Neuromuscular Diseases / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D012600:Scoliosis / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult