Sacropelvic Fixation: A Comprehensive Review.

Area of Science:

• Spine surgery
• Orthopedic biomechanics
• Spinal fusion

Background:

• Sacropelvic fixation is crucial for long spinal fusions, spondylolisthesis reduction, and sacral fracture repair.
• The sacropelvis presents anatomical challenges and poor bone quality, complicating lumbosacral junction fusion.
• Advances in understanding spinal biomechanics have significantly improved fusion rates.

Purpose of the Study:

• To review the anatomy and biomechanics of the lumbosacral junction.
• To summarize current sacropelvic fixation techniques, focusing on widely used methods.
• To highlight challenges and advancements in achieving solid sacropelvic fusion.

Main Methods:

• Review of regional anatomy and biomechanics of the lumbosacral junction.
• Summary of sacropelvic fixation techniques, emphasizing iliac screws and S2-alar-iliac screws.
• Analysis of biomechanical principles underlying newer fixation methods.

Main Results:

• Newer fixation techniques achieve bony purchase anterior to the pivot point, enhancing biomechanical stability.
• Iliac screws and S2-alar-iliac screws are the most common techniques, associated with high fusion rates.
• Instrumentation-related pain and reoperation remain significant issues despite high fusion success.

Conclusions:

• Understanding sacropelvic anatomy and biomechanics is key to successful spinal fusion.
• Current fixation techniques offer improved fusion rates but have associated complications.
• Further research is needed to address instrumentation-related morbidity in sacropelvic fixation.