The role of transpedicular fixation systems for stabilization of the lumbar spine

Transpedicular fixation devices are extremely useful tools to achieve stabilization of the lumbosacral spine. The indications for the use of these systems are still evolving. These systems are able to obtain rigid fixation in vertebra lacking posterior elements, obtain solid sacral fixation, connect vertebra without distraction and maintain lordosis, fuse short spinal segments, and preserve motion segments. Stable, short segment constructs can be achieved even in the face of the most radical decompressions and vertebral resection. This technique is not, however, without risks. A thorough understanding of pedicle anatomy, pedicle screw insertion technique, fusion biology, and biomechanical considerations are paramount to achieve safe stabilization of the lumbosacral spine with this technique.