57 Sacropelvic Fixation in Spinal Deformity

Abstract

Sacropelvic fixation is an essential component in the treatment of complex spinal deformities, among other spinal pathologies. Historically, successful sacropelvic fixation has been challenging for a number of reasons, including complex local anatomy and high biomechanical stresses on instrumentation in this region. In response to this challenge, various techniques have been developed to achieve improved rates of fixation, beginning with the Luque-Galveston intrailiac rod technique in 1988. Since this time, other techniques have been developed including iliac screws, instrasacral rods, transiliac rods, and the S2-Alar-Iliac screw technique. Currently, the Galveston technique, iliac screw technique, and S2AI techniques are the most frequently utilized options. Complications associated with sacropelvic fixation include neurologic, vascular, or visceral injury, injury to the SI joint, and skin breakdown over prominent instrumentation. The S2AI technique has a number of advantages when compared to iliac screws or Galveston rods such as lower rates of pseudarthrosis, wound complications, and implant failure. Emerging developments include the use of minimally invasive and robotic spine surgery, in addition to freehand S2AI techniques, that are gaining popularity with the premise of lower complication rates and greater accuracy of screw placement. Although larger studies are needed to evaluate the clinical outcomes associated with such recent developments, spine surgeons should familiarize themselves with these advancements nonetheless.