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Medical Rounds

Orthopaedic Surgery: The Fix Is In

A new pelvic fixation technique pioneered by two orthopaedic surgeons at Johns Hopkins is turning previously hopeless cases of spinal deformity into surgical candidates.

Khaled Kebaish, director of the Spine Fellowship Program in the Department of Orthopaedic Surgery, recently performed the procedure on a patient who had already undergone 39 surgeries at other hospitals. “The main reason she had so many procedures is that they did not achieve good enough fixation in the pelvis. She could have been saved so many surgeries by simply having had this new, simple S2-alar-iliac technique,” says Kebaish.

The S2AI technique involves advancing a screw through the ala, thereby providing more purchase across the sacroiliac joint and into the ilium. “Rather than just holding onto the sacrum, you now have a stable anchor in the ilium,” says Kebaish, who developed the procedure with Paul Sponseller, director of pediatric orthopaedic surgery.

“This technique is more biomechanically stable than the old iliac technique,” says Kebaish. “From start to finish, it is easier: Easy to connect. Easy to teach. It uses only one rod and no connectors. It is a much simpler way to reduce the deformity, correct the deformity and then connect everything together. Additionally, we reduced the costs by using fewer implants and minimizing operative time.”

Most importantly, complication rates are low with the S2AI technique. In a two-year follow-up study of more than 300 patients, Kebaish and colleagues found that “the revision rate was almost nonexistent, very low, especially revision related to the S2AI or the pelvic fixation, which in some studies was as much as 20 to 30 percent with the previous technique.”