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James H. Nguyen, Thomas J. Buell, Tony R. Wang, Jeffrey P. Mullin, Marcus D. Mazur, Juanita Garces, Davis G. Taylor, Chun-Po Yen, Christopher I. Shaffrey and Justin S. Smith

, pelvic fixation is considered challenging, with previously reported high rates of mechanical failure (12%–57%), particularly in the setting of revision surgery and adult spinal deformity (ASD). 1 , 4 , 5 , 7 , 8 , 11 , 17 , 27 , 29 Several methods have been developed for pelvic fixation. In recent years, iliac screws and S2 alar iliac (S2AI) screws have been used most commonly. Iliac screws have a long, established history of being inserted for spinopelvic fixation. Advantages include large diameter and length, ease of application, preservation of the sacroiliac (SI

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Rafael De la Garza Ramos, Jonathan Nakhla, Daniel M. Sciubba and Reza Yassari

S pinopelvic fixation can be used in the correction of high-grade spondylolisthesis or pelvic obliquity; in cases of lumbopelvic trauma or after a sacrectomy/lumbar spondylectomy in tumors or infection; and after long-segment fusion procedures for pediatric or adult spinal deformity. 14 Advantages of fixation to the pelvis include greater construct strength, which is particularly useful given the high biomechanical forces in lumbosacral zone. 10 A variety of techniques have been described throughout the years, 10 but currently iliac screw (IS) fixation and S2

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J. Mason DePasse, Mauricio Valdes, Mark A. Palumbo, Alan H. Daniels and Craig P. Eberson

S pinopelvic fixation is essential for reinforcing long fusions to the sacrum in spinal deformity surgery. This instrumentation technique has also been applied in spinal trauma, tumor, and degenerative conditions. 4 , 9 , 13 Although several methods for pelvic fixation have been described, iliac screw and S-2 alar/iliac (S2AI) screw fixation are currently the most commonly used methods. 5 , 6 , 8 Traditional iliac screw fixation improves stability and fusion rate. 10 , 14 However, the screw head can be prominent and the technique has been associated with

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Shunsuke Fujibayashi, Masashi Neo and Takashi Nakamura

iliac rod or screw fixation. When the body and/or pedicles of the sacrum are compromised by tumor metastasis, the use of sacral PSs is not feasible. For these reasons, it is often necessary to perform lumbar–ilium fixation. In this study, we successfully treated metastatic neoplasms at the LSJ using a dual iliac screw fixation method. The surgical technique for secure screw placement and the clinical results are presented. Clinical Material and Methods Patient Population Between April 1999 and October 2002, five cases of metastatic spinal disease were

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Rajiv Saigal, Darryl Lau, Rishi Wadhwa, Hai Le, Morsi Khashan, Sigurd Berven, Dean Chou and Praveen V. Mummaneni

The addition of iliac screws decreases lumbosacral screw strain, 6 , 8–10 which may lower the incidence of screw pullout, L5–S1 pseudarthrosis, and sacral insufficiency fracture at S1–2. Iliac fixation screws serve as temporary scaffolding to allow for the maturation of bony fusion across the lumbosacral junction. 7 , 14 The iliac screw fixation technique classically involves screw placement on both sides of the pelvis. Theoretically, the bilateral iliac screw placement was thought to offer greater sacropelvic stability and construct strength than unilateral

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Michael Y. Wang, Steven C. Ludwig, D. Greg Anderson and Praveen V. Mummaneni

–S1 pseudarthrosis Although the placement of iliac screws has become widely accepted, sufficient lateral muscular dissection over the posterior superior iliac spine is typically necessary to expose the screw entry points. Pain secondary to iliac screw placement can be attributed to hardware prominence, disruption of the sacroiliac joint, and screw loosening. 3 However, local soft-tissue destruction and muscular devitalization may also play a role. Other regional percutaneous pelvic fixation techniques have already been described, most notably with iliosacral

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Edward Rainier G. Santos, Jonathan N. Sembrano, Benjamin Mueller and David W. Polly

. Iliac screw fixation has been shown to have biomechanical advantages over other spinopelvic fixation methods and has therefore gained popularity. 7 , 13 At present, there is great variability in the clinical use of iliac screws in terms of screw trajectory, diameter, and length. The starting point for insertion is typically the PSIS. Two trajectories can then be taken ( Fig. 1 ). 5 One trajectory is directed toward the superior portion of the acetabulum (supraacetabular trajectory). Another path is directed toward the AIIS (AIIS trajectory). To our knowledge, there

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Loyola V. Gressot, Akash J. Patel, Steven W. Hwang, Daniel H. Fulkerson and Andrew Jea

adults, the operative techniques focus on either bone anatomical landmarks or require additional image guidance consisting of multiple views, and do not confirm screw placement with CT, considered by many authors to be the gold standard. 15 , 16 We have therefore sought to validate a less invasive technique for iliac screw placement, consisting of exposure of the posterior superior iliac spine and pelvic inlet anteroposterior fluoroscopy only for coronal guidance alone. The primary goal of this study was to demonstrate the feasibility and safety of placing iliac

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Muhammed Yaser Hasan and Gabriel Liu

. 4 , 14 Lumbosacral junction fixation techniques over the last 5 decades have evolved from the early use of Harrington rods 9 to Allen and Ferguson’s Galveston technique 2 to present-generation iliac screw constructs. In 2008 Wang et al. introduced minimally invasive (MI) iliac screw fixation in degenerative spinal disease to reduce wound complications and blood loss. 18 In a recent study, Liu et al. demonstrated the effective use of MI iliac screw lumbosacral fixation as a palliative treatment in advanced, unstable, LSJ metastatic spinal deformity. 11 However

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Tobias A. Mattei and Daniel R. Fassett

useful in many clinical scenarios such as adult degenerative scoliosis, flat-back syndrome and kyphosis, pelvic obliquity, high-grade spondylolisthesis, extensive sacropelvic tumor resection, and fracture dislocations involving the lumbosacral junction. 5 , 13 , 19 , 26 , 29 , 30 , 34 , 40 According to a recent study, approximately 15% of ambulatory patients undergoing pelvic fixation with iliac screws below an extensive thoracolumbar fusion will develop pseudarthrosis with broken implants. 11 Nonunion in the lumbosacral region will occur in approximately one