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Pelvic Fixation in Adult Spinal Deformity: Complications, Controversies, and Future Directions
Kristen E Jones1,2, Kenneth J Holton1, Bryan Ladd1
1Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
Global Spine Journal
|July 9, 2025
Summary
Pelvic fixation in adult spinal deformity surgery shows high complication rates with both S2AI and iliac screws. Further research is needed to optimize techniques and clarify sacroiliac joint pain roles.
Area of Science:
- Spine Surgery
- Orthopedics
- Biomechanical Engineering
Background:
- Pelvic fixation is essential in adult spinal deformity surgery.
- High complication and failure rates persist despite its use.
- Optimal pelvic fixation techniques remain debated.
Purpose of the Study:
- To review literature on pelvic fixation techniques, complications, and outcomes.
- To discuss controversies surrounding pelvic fixation.
- To suggest future research directions in spinopelvic fixation.
Main Methods:
- Conducted a narrative review of PubMed literature from 2000-2022.
- Searched for terms including "spinopelvic fixation", "S2AI screw", "iliac screw", "adult spinal deformity", and "complications".
- Included 22 articles comparing S2AI vs. iliac screws or reporting on single techniques.
Main Results:
- Complications included mechanical failure, pseudarthrosis, infection, sacroiliac joint pain, and revision.
- Four studies indicated lower complication rates for S2AI screws compared to iliac screws.
- Reported complication frequencies varied widely, with high rates for screw loosening and sacroiliac joint pain.
Conclusions:
- Both S2AI and iliac screws offer significant stability for sacral constructs.
- Further investigation is required to determine optimal numbers of fixation points.
- The role of pelvic fixation in sacroiliac joint pain requires clarification.
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