182. Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors

Martin, Christopher T.; Polly, David W.; Holton, Kenneth J.; Elder, Benjamin D.; Fogelson, Jeremy L.; Mikula, Anthony L.; Kleck, Christopher; Burger, Evalina L.; Calabrese, David; Ou-Yang, David; Kim, Hee Jin; Lovecchio, Francis; Hu, Serena S.; Wood, Kirkham B.; Harper, R. Douglas; Yoon, S. Tim; Michael, Keith W.; Ananthakrishnan, Dheera; Schell, Adam; Lieberman, Isador H.; Kisinde, Stanley; Phillips, Frank M.; Nolte, Michael T.; Gelb, Daniel E.; Kim, Terrence T.; Ross, Lindsey; Anand, Neel; Cheng, Joseph; Plummer, Zachary J; Park, Paul; Oppenlander, Mark E.; Mummaneni, Praveen V.; Sembrano, Jonathan N.; Jones, Kristen E.

doi:10.1016/j.spinee.2021.05.389

The Spine Journal

2021

DOI: 10.1016/j.spinee.2021.05.389

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182. Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors

Christopher T. Martin

David W. Polly

Kenneth J. Holton

et al.

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“…At our institution, we identified a 5% acute pelvic fixation failure rate over an 18-month period 10 . In a subsequent multicenter retrospective series, a similar 5% acute pelvic fixation failure rate was also reported 11 . In response to these findings, our institution changed its pelvic fixation strategies to incorporate multiple points of pelvic fixation.…”

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Multiple Points of Pelvic Fixation

Polly

Holton

Soriano

et al. 2022

JBJS Essential Surgical Techniques

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Background:Sacropelvic fixation is a continually evolving technique in the treatment of adult spinal deformity. The 2 most widely utilized techniques are iliac screw fixation and S2-alar-iliac (S2AI) screw fixation1-3. The use of these techniques at the base of long fusion constructs, with the goal of providing a solid base to maintain surgical correction, has improved fusion rates and decreased rates of revision4.Description:The procedure is performed with the patient under general anesthesia in the prone position and with use of 3D computer navigation based on intraoperative cone-beam computed tomography (CT) imaging. A standard open posterior approach with a midline incision and subperiosteal exposure of the proximal spine and sacrum is performed. Standard S2AI screw placement is performed. The S2AI starting point is on the dorsal sacrum 2 to 3 mm above the S2 foramen, aiming as caudal as possible in the teardrop. A navigated awl is utilized to establish the screw trajectory, passing through the sacrum, across the sacroiliac (SI) joint, and into the ilium. The track is serially tapped with use of navigated taps, 6.5 mm followed by 9.5 mm, under power. The screw is then placed under power with use of a navigated screwdriver.Proper placement of the caudal implant is vital as it allows for ample room for subsequent instrumentation. The additional point of pelvic fixation can be an S2AI screw or a triangular titanium rod (TTR). This additional implant is placed cephalad to the trajectory of the S2AI screw. A starting point 2 to 3 mm proximal to the S2AI screw tulip head on the sacral ala provides enough clearance and also helps to keep the implant low enough in the teardrop that it is likely to stay within bone. More proximal starting points should be avoided as they will result in a cephalad breach.For procedures with an additional point of pelvic fixation, the cephalad S2AI screw can be placed using the previously described method. For placement of the TTR, the starting point is marked with a burr. A navigated drill guide is utilized to first pass a drill bit to create a pilot hole, followed by a guide pin proximal to the S2AI screw in the teardrop. Drilling the tip of the guide pin into the distal, lateral iliac cortex prevents pin backout during the subsequent steps. A cannulated drill is then passed over the guide pin, traveling from the sacral ala and breaching the SI joint into the pelvis. A navigated broach is then utilized to create a track for the implant. The flat side of the triangular broach is turned toward the S2AI screw in order to help the implant sit as close as possible to the screw and to allow the implant to be as low as possible in the teardrop. The navigation system is utilized to choose the maximum possible implant length. The TTR is then passed over the guide pin and impacted to the appropriate depth. Multiplanar post-placement fluoroscopic images and an additional intraoperative CT scan of the pelvis are obtained to verify instrumentation position.Alternatives:The use of spinopelvic fixati...

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Multiple Points of Pelvic Fixation

Polly

Holton

Soriano

et al. 2022

JBJS Essential Surgical Techniques

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Pelvic Fixation Construct Trends in Spinal Deformity Surgery

Ormseth,

Odland,

Haselhuhn

et al. 2024

JOIO

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182. Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors

Cited by 2 publications

References 0 publications

Multiple Points of Pelvic Fixation

Multiple Points of Pelvic Fixation

Pelvic Fixation Construct Trends in Spinal Deformity Surgery

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