D istal fixation in thoracolumbar spinal deformity surgery is crucial when arthrodesis to the sacrum is indicated. 10 Multiple studies have shown that long instrumentation and fusion to the sacrum without supplemental pelvic fixation predisposes to fixation failure and reoperation. 3 , 4 , 12 Kim and colleagues 6 have shown that the L5–S1 junction is the single level with the highest incidence of pseudarthrosis in adult scoliosis surgery, with a rate of 24%. Pseudarthrosis in adult thoracolumbar spinal deformity surgery is associated with adverse clinical
Lauren E. Matteini, Khaled M. Kebaish, W. Robert Volk, Patrick F. Bergin, Warren D. Yu, and Joseph R. O'Brien
Marcus D. Mazur, Vijay M. Ravindra, Meic H. Schmidt, Darrel S. Brodke, Brandon D. Lawrence, Jay Riva-Cambrin, and Andrew T. Dailey
deformity surgery are an important factor to be considered in the initial decision to proceed with surgery. There has been an increase in the use of lumbopelvic fixation to potentially decrease complications and improve results. It is often used to correct pelvic obliquity, reduce strain on S-1 pedicle screws, provide rigid immobilization for L5–S1, repair pseudarthrosis, reduce high-grade spondylolisthesis, or bolster the caudal end of a construct spanning a lumbosacral defect due to infection or tumors. The recently developed method of pelvic fixation using S-2 alar
Rajiv Saigal, Darryl Lau, Rishi Wadhwa, Hai Le, Morsi Khashan, Sigurd Berven, Dean Chou, and Praveen V. Mummaneni
PD , Parazin SJ , Khanna AJ , Kebaish KM , : Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques . J Bone Joint Surg Am 87 : Suppl 2 89 – 106 , 2005 12 Shen FH , Mason JR , Shimer AL , Arlet VM : Pelvic fixation for adult scoliosis . Eur Spine J 22 : Suppl 2 S265 – S275 , 2013 13 Tomlinson T , Chen J , Upasani V , Mahar A : Unilateral and bilateral sacropelvic fixation result in similar construct biomechanics . Spine (Phila Pa 1976) 33 : 2127 – 2133
Richard Menger, Paul J. Park, Elise C. Bixby, Gerard Marciano, Meghan Cerpa, David Roye, Benjamin D. Roye, Michael Vitale, and Lawrence Lenke
New York operative database. Inclusion criteria were pediatric patients with any ambulatory capacity undergoing fusion to the pelvis for spinal deformity. Demographic information was extracted, including age, sex, race, operative etiology, presence of previous spine surgery, and diagnosis. The appropriate risk severity score was applied. Operative information consisted of the upper instrumented vertebra (UIV), type of pelvic fixation, use of osteotomy, blood loss, use of the pelvic kickstand technique, use of preoperative halo fixation, and surgical approach
Muhammed Yaser Hasan and Gabriel Liu
The management of lumbosacral neoplastic disease can be demanding, often requiring complex reconstruction. In the context of extensive sacral involvement, the risk of iliac screw breakage is greater. Few studies advocate the use of dual iliac screw techniques to reduce implant failure. In this report, the authors have described the first case of percutaneous dual iliac screw, dual rod insertion as part of a minimally invasive spinopelvic stabilization in a patient with a sacral fracture from a paraganglionoma. The patient underwent percutaneous L-2 to ilium fixation. A dual iliac screw, dual rod construct was used for stabilizing the left lumbopelvic junction. At the 1-year follow-up, the patient remained asymptomatic, with radiographs showing no signs of instrumentation failure. Minimally invasive dual iliac screw, dual rod fixation is a viable option in cases in which additional stability is required due to extensive neoplastic disease or active individuals have increased functional demands. Short-term results in this report are encouraging; however, more research is warranted to establish the procedure’s long-term safety.
Michel Lefranc, F. François Deroussen, and Richard Gouron
Fusionless surgery coupled with growing rod techniques is increasingly advocated for the treatment of early-onset scoliosis in general and neuromuscular scoliosis in particular. Iliosacral screws have excellent biomechanical characteristics but are hard to place safely. Here, the authors report on robot-assisted iliosacral screw positioning as part of growing rod surgery for the fusionless correction of early-onset scoliosis. The technique is based on a bilateral double sliding rod construct anchored to the pelvis proximally with 6 hooks or sublaminar bands and distally with iliosacral screws placed by the robot.
The video can be found here: https://youtu.be/5HGH_DiD-ck.
D. Kojo Hamilton, Justin S. Smith, Tanya Nguyen, Vincent Arlet, Manish K. Kasliwal, and Christopher I. Shaffrey
surgery and sexual function, our objective in the present study was to assess sexual function among older adults following thoracolumbar to pelvic fixation for spinal deformity. Methods This was a retrospective review of consecutive cases from a single surgeon at a tertiary care, academic medical center with a high volume of adult patients with scoliosis. Surgeon case logs were reviewed for patients meeting the following inclusion criteria: age ≥50 years, diagnosis of spinal deformity, surgical treatment with posterior thoracolumbar instrumentation (including
Michael M. Safaee, Cecilia L. Dalle Ore, Corinna C. Zygourakis, Vedat Deviren, and Christopher P. Ames
single institution by 2 surgeons (V.D. and C.P.A). Patient demographics and surgical characteristics, including age, sex, indication for surgery, number of levels fused, use of bone morphogenetic protein (BMP), vertebroplasty (Cortoss cement, Stryker), hook fixation at the UIV (for constructs terminating in the upper thoracic spine), ligament augmentation (LigaPASS cable, Medicrea), 3-column osteotomy, and pelvic fixation, were collected. Vertebroplasty, performed by tapping the cannulated pedicle screw trajectories and filling them with thrombin-containing hemostatic
Hong-Lei Yi, Michael Faloon, Stuart Changoor, Thomas Ross, and Oheneba Boachie-Adjei
primary adult scoliosis Variable TSF, n = 18 TLIF, n = 18 p Value Average age in yrs 57.33 ± 5.01 57.89 ± 6.98 0.81 Sex (F/M) 17/1 16/2 Diagnosis Idiopathic scoliosis 9 9 De novo scoliosis 9 8 Kyphoscoliosis 0 1 Osteoporosis/osteopenia 2/8 0/7 0.49 BMI 24.61 ± 3.72 23.44 ± 3.47 0.38 No. of fusion vertebrae 14.00 ± 3.16 10.94 ± 3.61 0.01 Pelvic fixation 8 15 0.015 Follow-up in mos 28.67 ± 4.47 33.44 ± 11.53 0.12 Continuous variables are expressed as the mean ± SD. Surgical Techniques For each of the patients, correction of deformity was performed prior to discectomy
Sei Yano, Yasuchika Aoki, Atsuya Watanabe, Takayuki Nakajima, Makoto Takazawa, Hiroyuki Hirasawa, Kazuhisa Takahashi, Koichi Nakagawa, Arata Nakajima, Hiroshi Takahashi, Sumihisa Orita, Yawara Eguchi, Takane Suzuki, and Seiji Ohtori
spinous process. Before tightening the rods to the iliac screws, displacement of the pelvic fracture was gently reduced by manually pressing the bilateral ilia. Following pelvic fixation, pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides. A 2-cm skin incision allowed insertion of pedicle screws percutaneously, using a percutaneous pedicle screw system (X-tab, DePuy Synthes Spine). A rod was inserted from the rod guide sleeve connected to the L-4 pedicle screw and advanced caudally through the L-5 rod guidance sleeve to the cranial rod