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Lauren E. Matteini, Khaled M. Kebaish, W. Robert Volk, Patrick F. Bergin, Warren D. Yu, and Joseph R. O'Brien

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

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Tobias A. Mattei and Daniel R. Fassett

M ultiple studies have demonstrated that pedicle screw fixation alone is less effective in osteoporotic patients undergoing deformity surgery than in other patients. 6 , 9 , 23 , 27 Previous investigations of the mechanisms that lead to failure of fixation after fusion have shown that translational motion, causing a windshield-wiper effect and loosening of the screws, may be an important cause of pseudarthrosis. 8 , 14 Pelvic fixation is an important tool in the armamentarium of complex deformity surgery, and this fixation technique has proved to be

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Robert J. Jackson and Ziya L. Gokaslan

ilium fixation, thereby bypassing the sacrum. Allen and Ferguson 2–5 originally described performing a lumbar—ilium L-rod pelvic fixation to treat scoliosis, pelvic obliquity, and degenerative processes of the LSJ, which became known as the Galveston technique of pelvic fixation. We have modified this fixation technique by using lumbar pedicle screw fixation in place of sublaminar wire in patients with spinal—pelvic instability secondary to lumbosacral tumors. With particular attention to method, pain relief, and neurological status, we have retrospectively

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Harry Mushlin, Daina M. Brooks, Joshua Olexa, Bryan J. Ferrick, Stephen Carbine, Gerald M. Hayward II, Brandon S. Bucklen, and Charles A. Sansur

of pelvic fixation and SIJF in lumbosacral fusion. The objective of this biomechanical investigation was to understand the effect of various long fusion constructs on the range of motion (ROM) of the SIJ and lumbosacral junction (L5–S1). Methods Specimen Preparation We used seven fresh-frozen human cadaveric specimens with an intact region from the T9 vertebra to the pelvis. Specimens were radiographed in the anteroposterior and lateral planes to confirm the absence of fractures, deformities, degeneration, and other significant osseous pathology. Thoracolumbar

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Wilson Z. Ray, Vijay M. Ravindra, Meic H. Schmidt, and Andrew T. Dailey

F usion to the sacrum is a crucial adjunct to many lumbar fusions requiring supplemental pelvic fixation. Biomechanically, inclusion of the sacrum in a long construct can provide a significant challenge. 12 , 20 Multiple authors have reported a high rate of pseudarthrosis and complications at the L5–S1 junction with scoliosis surgery. 8 , 12 , 13 The most popular method to supplement fusion to the sacrum, iliac fixation, has several drawbacks, including hardware prominence, the need for extensive muscle dissection, and the need for connection devices. 4

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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

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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

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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

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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

T he addition of pelvic fixation to spinal instrumentation and fusion has been established as an important technique to reduce complications and promote fusion at the lumbosacral junction. Extending instrumentation to the ilium provides a strong distal foundation to resist the substantial cantilever forces above and reduces strain on the sacrum. Indications for pelvic fixation include long-segment fusions to the sacrum, high-grade spondylolisthesis, sacral fractures, significant osteoporosis, and correction of pelvic obliquity. 1 , 3 , 11 , 12 , 21 , 26 Still

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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.