title: Minimally invasive iliac screw fixation in treating painful metastatic lumbosacral deformity: a technique description and clinical results.
abstract: Pelvic fixation via iliac screws is a crucial technique in stabilizing metastatic lumbosacral deformity. MIS iliac screw fixation avoids complications of an open approach and is a viable palliative option in treating patients with painful instability and advanced disease, unsuited for major reconstruction. In this paper we describe the use of MIS iliac screw fixation in treatment of painful metastatic LSJ deformity, highlighting our treatment rationale, selection criteria, technical experience and outcomes.
  
  
  
  Five patients with lumbosacral metastatic deformity who underwent MIS lumbopelvic stabilization using iliac screws were prospectively studied. Patients had severe axial back pain in erect posture with significant resolution when supine. All patients had advanced disease with unfavorable tumor scores for major spinal reconstruction.
  
  
  
  Mean cohort age was 62 years. Median pre-op SIN and Tokuhashi scores were 13 and 9, respectively. All patients were instrumented successfully without conversion to open technique. Mean preoperative and postoperative Cobb angle was 11° and 5.4°, respectively. There were no neurological deficits or wound complications postop. Postoperative CT scans showed no iliac screw and sacroiliac joint bony violation. Mean time for commencement of adjuvant therapy was 2.8 weeks. Average follow-up was 13.2 months. No screw breakage, wound complication, symptomatic implant prominence and SI joint pain were noted at last follow-up.
  
  
  
  MIS iliac screw fixation is feasible, reproducible and can be employed without complications in metastatic spine. This opens a new avenue of surgical management for metastatic lumbosacral disease patients, who otherwise may be inoperable and provide better soft tissue control and earlier postoperative adjuvant treatment opportunity.
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Surgery Cluster, National University Health System, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore. gabriel_liu@nuhs.edu.sg.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Liu
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Surgery Cluster, National University Health System, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: Muhammed Yaser
authors.initials: MY
authors.lastname: Hasan
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Surgery Cluster, National University Health System, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000368:Aged; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007085:Ilium / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011184:Postoperative Period; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary*; D014057:Tomography, X-Ray Computed
keywords: Bone screws; Lumbosacral region; Metastasis; Pathological fracture; Spine