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Sacral screws may be anchored to the anterior cortex.
Iliac screws have been shown to increase the stiffness of lumbosacral constructs, but disadvantages include difficulty in connecting the iliac screw to adjacent sacral screws, painful screw loosening or prominence requiring removal, and the inability to place the screws in some patients with previous iliac crest autograft harvest.
There was loosening of the axial lumbar interbody fusion screw and or loosening of the sacral screws with increasing clinical pain.
We found that accuracy of placement of lumbar pedicle screws was significantly improved by both of these measures; however, the accuracy was not significantly improved for thoracic and sacral screws.
Also, numerous alternative fixation techniques across the lumbosacral junction, such as iliosacral screws, coupled alar and sacral screws, S1 and S2 pedicle screws, intrasacral rodding, transvertebral L5-S1 fixatior, or Luque-Galveston technique, cannot be tested in this synthetic model [ 6, 27].
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To our knowledge, this is the first case of such a complication after sacral screw removal to be reported.
In this report, we describe a case of symptomatic cerebrospinal fluid fistulas after sacral screw removal in a young woman.
Open image in new window Fig. 3 Sagittal CT image illustrating the correct position of the sacral screw immediately after the operation (arrow).
A lumbosacral MRI was performed showing the presence of a lytic lesion involving the S1 and S2 bodies, which was judged to be a pseudomeningocele leaning against the sacral screw hole (Figs. 4, 5).
A lumbosacral MRI showed the presence of a lytic lesion involving the S1 and S2 bodies that was judged to be a pseudomeningocele leaning against the sacral screw hole and cerebrospinal fluid fistulas through this.
Additionally, we did not see any sacral insufficiency fractures or sacral screw loosening or breakage, except in cases that went on to pseudarthrosis.
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