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Takahito Fujimori, Shinichi Inoue, Hai Le, William W. Schairer, Sigurd H. Berven, Bobby K. Tay, Vedat Deviren, Shane Burch, Motoki Iwasaki and Serena S. Hu

A dult spinal deformity is a complex disease with various clinical and radiographic presentations. 22 Many studies have reported that positive sagittal imbalance is associated with worse clinical outcomes. 9 , 19 Schwab et al. classified cases in which patients had a sagittal vertical axis (SVA) ≥ 40 mm with the SVA modifier “+” 20 because of the negative effect that a positive SVA had on patient outcomes. Long fusion from the sacrum to the thoracic spine is a common surgical treatment option to correct for sagittal imbalance. 5 , 6 , 13 , 15–17 , 21

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Hong-Lei Yi, Michael Faloon, Stuart Changoor, Thomas Ross and Oheneba Boachie-Adjei

S urgical correction of adult spinal deformity (ASD) often requires a long fusion from the thoracic spine across the lumbosacral junction in order to maintain stability and maximize patient outcomes. Pseudarthrosis is one of the most common complications encountered after long fusion to the sacrum, and typically occurs at lumbosacral junctions. Rates of pseudarthrosis at the lumbosacral junction have been reported to range from 10% to 16%. 10 , 12 , 18 , 19 Patients undergoing long fusions to the sacrum for deformity who develop pseudarthrosis may experience

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Hiroshi Miyamoto, Masatoshi Sumi and Koki Uno

are as follows: 1) it is still possible to injure the VA and the neural tissues that lie in front of the cervical spine, given the necessity of gaining purchase on the ventral cortex of the lateral mass and the facet, and 2) the fixation force is weaker than that of the PS. 14 , 17 , 18 For reconstruction of the cervical spine in cases of massive instability and misalignment due to RA and athetoid CP, posterior long fusion surgery can be indicated. However, this procedure is still challenging given the possibility of several major complications due to screw

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Keitaro Matsukawa, Takashi Kato, Ralph Mobbs, Yoshiyuki Yato and Takashi Asazuma

OBJECTIVE

Lumbosacral fixation plays an important role in the management of devastating spinal pathologies, including osteoporosis, fracture, infection, tumor resection, and spinal deformities, which require long-segment fusion constructs to the sacrum. The sacral-alar-iliac (SAI) screw technique has been developed as a promising solution to facilitate both minimal invasiveness and strong fixation. The rationale for SAI screw insertion is a medialized entry point away from the ilium and in line with cranial screws. The divergent screw path of the cortical bone trajectory (CBT) provides a higher amount of cortical bone purchase and strong screw fixation and has the potential to harmoniously align with SAI screws due to its medial starting point. However, there has been no report on the combination of these two techniques. The objective of this study was to assess the feasibility of this combination technique.

METHODS

The subjects consisted of 17 consecutive patients with a mean age of 74.2 ± 4.7 years who underwent posterior lumbosacral fixation for degenerative spinal pathologies using the combination of SAI and CBT fixation techniques. There were 8 patients with degenerative scoliosis, 7 with degenerative kyphosis, 1 with an osteoporotic vertebral fracture at L5, and 1 with vertebral metastasis at L5. Fusion zones included T10–sacrum in 13 patients, L2–sacrum in 2, and L4–sacrum in 2.

RESULTS

No patients required complicated rod bending or the use of a connector for rod assembly in the lumbosacral region. Postoperative CT performed within a week after surgery showed that all lumbosacral screws were in correct positions and there was no incidence of neurovascular injuries. The lumbosacral bone fusion was confirmed in 81.8% of patients at 1-year follow-up based on fine-cut CT scanning. No patient showed a significant loss of spinal alignment or rod fracture in the lumbosacral transitional region.

CONCLUSIONS

This is the first paper on the feasibility of a combination technique using SAI and CBT screws. This technique could be a valid option for lumbosacral fixation due to the ease of rod placement with potential reductions in operative time and blood loss.

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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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Minoru Ikenaga, Jitsuhiko Shikata, Mitsuru Takemoto and Chiaki Tanaka

-onset progression of kyphosis was significantly lower in patients with a long fusion (from a middle thoracic vertebra [T5–8] to the sacrum or pelvis) than in patients with a shorter fusion (p = 0.04, chi-square test). Age did not differ significantly between patients with a long fusion (mean age 71.9 ± 5.2 years) and those with a short fusion (mean age 67.6 ± 11.7 years, p = 0.24, Mann–Whitney U-test). The preoperative C-7 plumb line values in patients with or without progression of kyphosis were 3.9 ± 4.0 cm and 2.5 ± 2.0 cm, respectively. Postoperative C-7 plumb line values

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Selection of instrumentation and fusion levels for scoliosis: where to start and where to stop

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Keith H. Bridwell

. Lower: Preoperative and postoperative SRS scores converted to 100-point scale. Extending a long fusion to the sacrum is extremely difficult. For a successful solid fusion to form, the following factors are necessary: 1) segmental fixation without jumps or gaps from the middle lumbar spine to the sacrum; 2) four-point fixation of the sacrum and pelvis to protect the S-1 screws; 3) bicortical S-1 screws; 4) load-sharing ability with anterior-column support/anterior fusion in the distal lumbar spine, if not the entire lumbar spine; and 5) neutral or negative

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Bang-ping Qian, Ji-chen Huang, Yong Qiu, Bin Wang, Yang Yu, Ze-zhang Zhu, Sai-hu Mao and Jun Jiang

operating room, improved intraoperative anesthetic care, and careful postoperative nursing, contributed to the relatively low infection rate. The potential risk factors for complications in spinal osteotomy for AS patients were extensively investigated in this study. Age; preoperative GK, LL, and SVA; correction of GK, LL, and SVA; 2-level PSO; and long fusion were identified as risk factors. Our findings were comparable to those of prior studies reporting complications in adult spinal deformity (ASD). In agreement with previous ASD studies, 9 , 11 , 25 our study showed

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Dominic Amara, Praveen V. Mummaneni, Christopher P. Ames, Bobby Tay, Vedat Deviren, Shane Burch, Sigurd H. Berven and Dean Chou

SK , Shin JI , Kim YJ : Proximal junctional kyphosis following adult spinal deformity surgery . Eur Spine J 23 : 2726 – 2736 , 2014 25186826 10.1007/s00586-014-3531-4 3 Fu X , Sun XL , Harris JA , Sheng SR , Xu HZ , Chi YL , : Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis . BMJ Open 6 : e012103 , 2016 27852709 10.1136/bmjopen-2016-012103 4 Glassman SD , Bridwell K , Dimar JR

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Aaron J. Clark, Jessica A. Tang, Jeremi M. Leasure, Michael E. Ivan, Dimitriy Kondrashov, Jenni M. Buckley, Vedat Deviren and Christopher P. Ames

testing was conducted to simulate the low-level physiological activity expected during the early postoperative period following this major surgical intervention (Stanley, personal communication, 2004). Compression and flexion activity was simulated with our custom-designed long fusion gait model ( Fig. 3 ). Compression (300 N), anterior shear (100 N), and flexion moment (8 Nm) were applied to each of the 15 specimens at 1 Hz for up to 250,000 cycles. The total cycle count for this protocol was derived from patient rehabilitation protocols during the early postoperative