title: Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan; Keio Spine Research Group (Clinical Research Group), Shinjuku, Tokyo, Japan; Society for Minimally Invasive Spine Stabilization (Clinical Research Group), Shinjuku, Tokyo, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Funao
authors.affiliation: Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.affiliation: Keio Spine Research Group (Clinical Research Group), Shinjuku, Tokyo, Japan; Society for Minimally Invasive Spine Stabilization (Clinical Research Group), Shinjuku, Tokyo, Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Isogai
authors.affiliation: Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan; Keio Spine Research Group (Clinical Research Group), Shinjuku, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Koyanagi
authors.affiliation: Keio Spine Research Group (Clinical Research Group), Shinjuku, Tokyo, Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Keio Spine Research Group (Clinical Research Group), Shinjuku, Tokyo, Japan; Society for Minimally Invasive Spine Stabilization (Clinical Research Group), Shinjuku, Tokyo, Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan. Electronic address: keni8888@z7.keio.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
mesh_terms: D000368:Aged; D001863:Bone Screws; D015299:Discitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery; D016867:Immunocompromised Host; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D053831:Surgical Fixation Devices
keywords: Iliac screw; Minimally invasive spine stabilization; Percutaneous S2-alar-iliac screw; S2-alar-iliac screw; Sacropelvic fixation; Spondylodiscitis