Sacropelvic fixation techniques - Current update

Abstract

Sacropelvic is a complex junctional area owing to the complex regional anatomy and higher biomechanical stress. However extension of construct is indicated in cases with complex deformities, high grade spondylolisthesis, and complex fractures. The challenges remain which includes pseudoarthrosis and fixation failures. The fixation techniques have constantly evolved over time with better results with iliac screws and S2-alar-iliac screws. This article gives background on evolution, biomechanics, and recent update of use of robotics for sacropelvic fixation.

Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience

“…Rather than placing a pedicle screw or tap, a large burr is inserted through the guide to facilitate facet decortication ( 40 , 41 ). Yet another advancement was shown in the cases of iliac fixation, where we were able to successfully perform iliolumbar fixation percutaneously without the need for a side connector, which is a potential place of weakness and failure ( 42 ). Of note, this technique has been implemented by various other groups in the literature and is currently expanding its usage ( 43 – 45 ).…”

Hardware Failure in Spinal Tumor Surgery: A Hallmark of Longer Survival?

“…In addition, proximal junctional disorders were observed frequently in fusion of the lumbar curve extending to the pelvis [ 26 ]. The synergistic effect of the high-stress environment of the lumbosacral spine coupled with a poor bone quality in a compromised patient had likely contributed to our findings [ 27 ]. Also, patients who require spinopelvic fixation may have had a more extensive disease requiring more resection of the tumor, resulting in more destabilization.…”

Sacroiliac Joint Pain Should Be Suspected in Early Buttock and Groin Pain after Adult Spinal Deformity Surgery: An Observational Study

“…The S2AI screw inserted from the sacrum into the ilium reportedly reduces the frequency of SIJP after spinal fusion 15,16 . This is attributed to the ability to insert S2AI screws without special attention to the physiological rotation axes such as SIJ nutations and counter-nutations 27,28 . On the other hand, loosening of the S2AI screw is considered a risk factor for SIJP [15][16][17] .…”

“…In this study, the following reasons could be considered the cause of SIJP despite the insertion of the S2AI screw. First, it is possible that the S2AI deviated from the physiological axis of rotation, such as nutations and counter-nutations 27,28 . Second, the S2AI screw, which penetrates the articular surface of the SIJ, may have damaged the joint and provoked an inflammatory response 29,30 .…”