Impact of Iliac Instrumentation on the Quality of Life of Patients With Adult Spine Deformity

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Study Design.Retrospective comparative analysis of data collected prospectively in an adult spine deformity (ASD) multicenter database.Objective.To evaluate the impact of the iliac screws on the quality of life of ASD patients compared with those instrumented above the pelvis (L5/S1/S2).Summary of Background Data.The impact on patient's daily activities and functions, of immobilizing the sacroiliac joint with iliac screws for the treatment of ASD is still underexplored.Methods.Inclusion criteria were ASD patients with a long arthrodesis of at least eight levels and whose lowest instrumented vertebrae (LIV) were L5 or below. We analyzed the following preoperative and 2 years’ follow-up variables: age, Cobb angle, coronal and sagittal alignment, number of instrumented levels, Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), Scoliosis Research Society-22 (SRS-22), and Short Form 36 (SF-36) questionnaires. Statistical analysis was performed with Mann–Whitney U test, and Wilcoxon test.Results.A total of 129 patients were included, and separated into two groups: “Iliac Yes,” with the LIV at the Ilium (N = 104), and “iliac No,” with the LIV at L5/S1/S2 (N = 25). Patients instrumented with Iliac screws were older (x = 66 vs. 56 yr, P = 0.008), and had lower Cobb magnitude (x = 31° vs. 45°, P = 0.019). No statistically significant differences were found in the health related quality of life (HRQOL) questionnaires prior to surgery or at 2-years’ follow up. The “Iliac Yes” group significantly improved all radiographic and HRQOL scores parameters 2 years after surgery (P < 0.005). While the “Iliac No” group failed to significantly improve (coronal balance, sagittal vertical axis, SF-36 Physical functioning, SF-36 General health, and COMI) (P > 0.05)Conclusion.ASD patients instrumented with iliac screws significantly improved all their HRQOL questionnaires 2 years after surgery. The 2 years’ postoperative HRQOL scores were similar in both groups, regardless of the sacroiliac joint immobilization. Therefore, with the currently available tools, we cannot state that iliac instrumentation has a negative influence on patient's quality of life.Level of Evidence: 4

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