Intrasacral Rod Fixation for Pediatric Long Spinal Fusion: Results of a Prospective Study With a Minimum 5-year Follow-up

• Published in: Journal of pediatric orthopaedics Vol. 29; no. 6; pp. 594 - 601
• Main Authors: Ilharreborde, Brice, Hoffmann, Etienne, Tavakoli, Said, Queinnec, Steffen, Fitoussi, Franck, Presedo, Ana, Penneçot, Georges-François, Mazda, Keyvan
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-09-2009; Lippincott Williams & Wilkins
• Subjects: Adolescent; Biological and medical sciences; Child; Diseases of the osteoarticular system; Diseases of the spine; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Humans; Internal Fixators; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Medical sciences; Neuromuscular Diseases - surgery; Orthopedic surgery; Prospective Studies; Radiography; Sacrum - diagnostic imaging; Sacrum - surgery; Scoliosis - surgery; Severity of Illness Index; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Young Adult; Human; Pediatrics; Deformation; Spine; Diseases of the osteoarticular system; Vertebra; Spine disease; Sacrum; Fixation; Treatment; sacral fixation; Scoliosis; Surgery; Orthopedics; neuromuscular scoliosis; deformity; Arthrodesis; Child
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0b013e3181b2b403

BACKGROUNDLumbosacral 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.
METHODSAll 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.
RESULTSFifty-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.
CONCLUSIONSJackson 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.
LEVEL OF EVIDENCEThis consecutive series provides level IV evidence.