Removal of painful pelvic screws following spine fusion surgery: outcomes and complications Article Swipe
Anthony L. Mikula
,
Zach Pennington
,
Nikita Lakomkin
,
Michael L. Martini
,
Abdelrahman M. Hamouda
,
Ahmad Nassr
,
Brett A. Freedman
,
Arjun S. Sebastian
,
William W. Cross
,
Christopher P. Ames
,
Benjamin D. Elder
,
Jeremy L. Fogelson
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3171/2025.3.focus2510
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3171/2025.3.focus2510
OBJECTIVE The purpose of this study was to evaluate the risks and benefits of removing painful pelvic/iliac screws in spine fusion surgery patients. METHODS A retrospective review identified patients who had traditional iliac and S2-alar-iliac (S2AI) screws removed for pain. The minimum follow-up was 24 months. RESULTS Fifty-two patients (75% women) were included with a mean age of 63 years, BMI of 28, and follow-up of 65 months. Most of the removed screws were S2AI (83%) compared with traditional iliac screws (17%). Forty-three patients (83%) had improvement in their pelvic screw related–pain following removal. Eight patients (15%) experienced lumbosacral mechanical complications following pelvic screw removal including sacral fracture (n = 3, 6%) and/or L4–5 or L5–S1 rod fracture (n = 7, 13%). On multivariable analysis, risk factors for mechanical complications following pelvic screw removal included a longer fusion construct (OR 1.34, p = 0.035), greater postoperative L4–S1 lordosis (OR 1.14, p = 0.04, ideal cutoff > 40°), and lack of bone morphogenetic protein (BMP; OR 0.03, p = 0.02). Ten patients (19%) underwent subsequent SI joint fusion following pelvic screw removal, and higher standing pelvic incidence (OR 1.10, p = 0.03) was the only independent predictor of SI fusion. CONCLUSIONS Removal of painful pelvic screws resulted in a high rate of postoperative pain relief, albeit with a risk of lumbosacral mechanical complications and subsequent SI joint fusion. Patients at risk for lumbosacral mechanical complications following pelvic screw removal included those with longer fusion constructs, more lordosis from L4 to S1 (> 40°), and lack of BMP. Patients at risk for receiving an instrumented SI joint fusion following pelvic screw removal included those with a higher pelvic incidence.
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Concepts
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3171/2025.3.focus2510
- OA Status
- diamond
- References
- 13
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4410936245
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4410936245Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.3171/2025.3.focus2510Digital Object Identifier
- Title
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Removal of painful pelvic screws following spine fusion surgery: outcomes and complicationsWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
-
2025-06-01Full publication date if available
- Authors
-
Anthony L. Mikula, Zach Pennington, Nikita Lakomkin, Michael L. Martini, Abdelrahman M. Hamouda, Ahmad Nassr, Brett A. Freedman, Arjun S. Sebastian, William W. Cross, Christopher P. Ames, Benjamin D. Elder, Jeremy L. FogelsonList of authors in order
- Landing page
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https://doi.org/10.3171/2025.3.focus2510Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
diamondOpen access status per OpenAlex
- OA URL
-
https://doi.org/10.3171/2025.3.focus2510Direct OA link when available
- Concepts
-
Medicine, Surgery, Lumbosacral joint, Pelvic fracture, Retrospective cohort study, Pelvis, Spinal fusionTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
0Total citation count in OpenAlex
- References (count)
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13Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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