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Abstract
Lumbosacral fixation or spinopelvic fixation is frequently required for the surgical treatment of neuromuscular scoliosis and degenerative lesions, trauma and tumor in the lumbosacral vertebrae. However, the establishment of stable fixation with these procedures is difficult due to the anatomic characteristics of the sacrum and this is even more problematic for the cases with long segmental fixation, severe instability and bone defects. Although the emergence of pedicle screws makes spinal fixation easier and more rigid, S1 pedicle screws alone do not provide enough stability for lumbosacral fixation. For the purposes of reinforcing lumbosacral fixation, procedures using rods or screws can be used: the procedures using rods include the Galveston method, the McCarthy S-rod and the Jackson intrasacral rod, and the procedures using screws include sacral alar screws, transdiscal screws and iliac screws. The purpose of this study was to ascertain the proper fixation methods, according to each indication, for spinopelvic fixation and we analyzed the advantages and drawbacks of each fixation method. In addition, the fixation method of iliac screws, which has recently become more popular, is presented in detail to enhance the availability and reduce the complication of this technique.
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Fig. 1. (A, B)
Galveston L-rod technique. Galveston rods were used to fix pelvis for residual poliomyelitis patient with paralytic scoliosis. Rods were connected to upper spine rods of pedicle screw system with parallel rod connectors.
Fig. 2. (A, B)
Iliac screw fixation for neuromuscular scoliosis. Iliac screws make strongest fixation to ilium and easier connection to rod with offset connectors. However, prominence of iliac screw head should be avoided carefully.
Fig. 3. (A, B)
Sub-S1 alar screw. Alar screws were added to enhance fixation of sacrum for patient with tubrculous spondylitis of L5 body after corpectomy and femoral shaft allograft. S1 pedicle screws were not enough for sacral fixation due to osteoporosis.
Fig. 4.
Iliac screw fixation for revision surgery. (A, B) Following several operations, implant fixation failure at the lower end and junctional kyphosis at the upper end had developed. (C, D) Revision with iliac screws and extension of proximal fixation were performed.
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