Comparison of Pelvic Fixation Techniques in Neuromuscular Spinal Deformity Correction: Galveston Rod Versus Iliac and Lumbosacral Screws

Abstract

In Brief Study Design. Retrospective radiographic and clinical review. Objective. To evaluate the safety and efficacy of iliac screws as a method of pelvic fixation in neuromuscular spinal deformity correction using the Galveston rod technique as a comparison group. Summary of Background Data. Sacropelvic fixation in patients with neuromuscular spinal deformity has traditionally used Galveston rods placed into the iliac wing. Difficulties with radiographic halos around the rods (loosening), rod contouring, and attaching to lumbar spine anchors have prompted their replacement with iliac screws. Methods. A minimum 2-year radiographic and clinical follow-up compared 20 patients with the Galveston technique to 20 patients with an iliac screw undergoing posterior spinal fusion (T2/T3-pelvis) for neuromuscular spinal deformity. All patients with the Galveston technique had sublaminar wires for their lumbar anchors, while the majority of patients with an iliac screw technique had at least 2 lumbar and/or sacral screws placed in addition to the iliac screws. Results. There were no significant differences between the 2 groups in preoperative, postoperative, and latest follow-up (mean 3.1 years) measurements for coronal Cobb measures, coronal and sagittal C7 plumblines, and T1 offset. Pelvic obliquity was similar in both groups preoperatively (22°) but at latest follow-up was statistically improved in the patients with an iliac screw (4.4°) versus those with the Galveston technique (7.3°) (P = 0.04). There were 13 patients with the Galveston technique versus 6 with an iliac screw who had radiolucent halos more than 2 mm around the pelvic anchor devices at latest follow-up (P < 0.05). The Galveston technique group had 4 broken rods and 2 reoperations, while the iliac screw group had 1 broken screw and no reoperations. Conclusions. Using iliac screws for pelvic fixation in neuromuscular spinal deformity affords equivalent maintenance of pelvic obliquity and scoliosis correction compared to the Galveston technique. Furthermore, the iliac screw technique avoids complex, lumbosacral 3-dimensional rod bends and yields minimal implant complications. A total of 40 patients undergoing neuromuscular spinal deformity correction with long fusions to the pelvis were compared based on the use of either the Galveston rod (n = 20) or an iliac screw technique (n = 20). Using iliac (and lumbar/sacral) screws for pelvic fixation in neuromuscular spinal deformity affords equivalent maintenance of pelvic obliquity and scoliosis correction, and minimal implant failures compared to the Galveston technique.