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Keitaro Matsukawa, Yoshiyuki Yato, Takashi Kato, Hideaki Imabayashi, Takashi Asazuma and Koichi Nemoto

, Kuklo TR , Belmont PJ Jr , Andersen RC , Polly DW Jr : Advantage of pedicle screw fixation directed into the apex of the sacral promontory over bicortical fixation: a biomechanical analysis . Spine (Phila Pa 1976) 27 : 806 – 811 , 2002 12 Leong JCY , Lu WW , Zheng Y , Zhu Q , Zhong S : Comparison of the strengths of lumbosacral fixation achieved with techniques using one and two triangulated sacral screws . Spine (Phila Pa 1976) 23 : 2289 – 2294 , 1998 13 Luk KDK , Chen L , Lu WW : A stronger bicortical sacral

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

T here is a growing demand for rigid lumbosacral fixation due to an increase in varieties of spinal pathologies in the aging population. From an anatomical point of view, the lumbosacral junction is one of the challenging spinal regions because of significant mechanical forces, poor sacral bone quality, complex anatomy, and proximity to major visceral structures, often leading to pseudarthrosis, hardware failure, and loss of correction. 1 Especially in the surgical management of adult spinal deformity, achieving sagittal global alignment through realizing

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Junichi Ohya, Todd D. Vogel, Sanjay S. Dhall, Sigurd Berven and Praveen V. Mummaneni

S-2 alar iliac (S2AI) screw fixation has recently been recognized as a useful technique for pelvic fixation. The authors demonstrate two cases where S2AI fixation was indicated: one case was a sacral insufficiency fracture following a long-segment fusion in a patient with a transitional S-1 vertebra; the other case involved pseudarthrosis following lumbosacral fixation. S2AI screws offer rigid fixation, low profile, and allow easy connection to the lumbosacral rod. The authors describe and demonstrate the surgical technique and nuances for the S2AI screw in a case with transitional S-1 anatomy and in a case with normal S-1 anatomy.

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Edward C. Benzel and Perry A. Ball

: Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am 17: 161–170, 1986 10. McCord DH , Cunningham BW , Shono Y , et al : Biomechanical analysis of lumbosacral fixation. Spine 17 : S235 – S243 , 1992 McCord DH, Cunningham BW, Shono Y, et al: Biomechanical analysis of lumbosacral fixation. Spine 17: S235–S243, 1992 11. McNamara MJ , Stephens GC , Spengler DM : Transpedicular short-segment fusions for treatment of lumbar burst fractures. J Spinal Disord

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Kentaro Yamada, Yuichiro Abe and Shigenobu Satoh

, Lawrence BD , Riva-Cambrin J , : Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts . J Neurosurg Spine 23 : 67 – 76 , 2015 25840042 10.3171/2014.10.SPINE14541 11 Nottmeier EW , Pirris SM , Balseiro S , Fenton D : Three-dimensional image-guided placement of S2 alar screws to adjunct or salvage lumbosacral fixation . Spine J 10 : 595 – 601 , 2010 10.1016/j.spinee.2010.03.023 20434406 12 OʼBrien JR , Yu W , Kaufman BE , Bucklen B , Salloum K , Khalil S , : Biomechanical evaluation of S2

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Vincenzo Amato, Luigi Giannachi, Claudio Irace and Claudio Corona

preoperative planning, accurate knowledge of the spinal anatomy, surgical experience, and correct indication for conventional surgery. The rates of complications not related to screw position also fall within the lowest band of the reported rates. Despite the improvement of technology, transpedicular screw fixation using conventional technique still remains a practical, safe, and effective surgical treatment for lumbosacral fixation. Disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in

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Everett G. Robert, Kenneth B. Fallon and Gabriel C. Tender

. Bone scanning together with abdominal, pelvic, and thoracic CT and MR imaging showed no additional lesions. Resection of the lesion resulted in neural foramina and spinal canal decompression, but led to spinal instability. Thus, pelvic and lumbosacral fixation was conducted ( Fig. 2 ). The morcellized L-4 and L-5 spinous processes supplemented with synthetic cancellous bone (Vitoss; Orthovita, Malvern, PA) were used as grafting material. Histological examination of the surgical specimen revealed emperipolesis, the pathognomonic feature of RDD 4 ( Fig. 1 right ). At

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lumbosacral fixation in patients with transitional and normal anatomy Junichi Ohya MD Todd D. Vogel MD Sanjay S. Dhall MD Sigurd Berven MD Praveen V. Mummaneni MD 7 2016 41 videosuppl1 1 1 10.3171/2016.2.FocusVid.1690 2016.2.FOCUSVID.1690 Minimally invasive L5–S1 oblique lumbar interbody fusion with anterior plate Martin H. Pham MD Andre M. Jakoi MD Patrick C. Hsieh MD 7 2016 41 videosuppl1 1 1 10.3171/2016.2.FocusVid.1692 2016.2.FOCUSVID.1692 S-1 and S-2-alar-iliac screw fixation via intraoperative navigation Martin H. Pham MD Andre M. Jakoi MD Patrick C. Hsieh MD 7 2016

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Shunsuke Fujibayashi, Masashi Neo and Takashi Nakamura

frequently pose a complex problem for surgical management and stabilization because of the anatomical and biomechanical factors of this transitional zone between the mobile spine and the relatively fixed pelvis. The inherent biomechanical factors of the LSJ combined with the destructive elements of the neoplastic process and its treatment present a challenging problem in terms of spinal stabilization. Various methods of lumbosacral fixation exist. These methods can be classified into the following three categories: the use of sublaminar devices, sacral screw fixation, or

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Robert J. Jackson and Ziya L. Gokaslan

required, such as in scoliosis and multilevel lumbosacral fixation, or in cases in which gross instability is demonstrated, such as that which occurs after large tumor resection or sacrectomy. Sacral pedicle screw pullout is a common complication in these cases of longer segment length. 10, 24, 25 In addition, because the body and/or pedicles of the sacrum are frequently compromised by tumor, they may be resected in patients with neoplasms in this region, making the use of sacral pedicle screws unfeasible. For these reasons it is often necessary to perform lumbar to