title: The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver.
abstract: METHODS
  Human cadavera morphometric analysis of the iliac columns and biomechanical implant testing of traditional Galveston technique compared to intrailiac instrumentation of the entire iliac column.
  
  
  OBJECTIVE
  To describe the anatomy of the iliac columns and to evaluate the strength in forward flexion of a large implant spanning the entire column length compared to standard Galveston technique.
  
  
  BACKGROUND
  We have observed substantial and straight columns of bone in the pelvis, connecting the acetabula to the sacrum, which may allow for improved spinopelvic instrumentation.
  
  
  METHODS
  Twenty adult cadaveric pelves were used. Each specimen was oriented in the computed tomography scanner to obtain a cross-section of the iliac columns, which begin from 2 cm caudal to the posterior iliac spines and end above the acetabula at the anterior inferior iliac spines. Two different instrumentation techniques were used. Standard Galveston pelvic fixation with paired 6.25-mm diameter rods extending 8 cm into the pelvis (Group 1) was compared to paired 8-mm diameter, 15-cm long custom implants, placed within the length of the entire iliac columns and connected to 6.25-mm spinal rods (Group 2). Both constructs had two rigid cross-links connecting the rods. Testing in forward flexion was performed for each construct with the MTS model 881 at 5 N/sec until failure occurred.
  
  
  RESULTS
  The rectangular shaped iliac columns averaged 15.2 (SD 0.8) cm in length, 2.5 (SD 0.3) cm in width and were consistently straight. The iliac column orientation as viewed in the transverse plane was 22 degrees laterally directed from the midsagittal plane. For the Galveston technique, failure with a flexion force occurred at a mean of 682 (SD 217) N. The iliac column implants failed at a mean of 2153 (SD 1370) N (P < 0.004).
  
  
  CONCLUSIONS
  The human adult pelvis has substantial and straight columns of bone extending from 2 cm below the posterior iliac spine, traversing above the sciatic notch, and ending at the anterior iliac spine. The shape resembles a weight-bearing long bone such as the tibia. Analogous to the architectural pylon, in this cadaver model, large implant instrumentation of the entire length of these pelvic columns provides at least three times stronger anchorage for spinal instrumentation compared to standard Galveston technique.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of New Mexico, Carrie Tingley Hospital, Albuquerque, New Mexico 87102, USA. rschwend@salud.unm.edu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Schwend
authors.forename: Romuald
authors.initials: R
authors.lastname: Sluyters
authors.forename: Jan
authors.initials: J
authors.lastname: Najdzionek
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007085:Ilium / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D020007:Implants, Experimental / Q000706:statistics & numerical data; D008161:Lumbosacral Region; D008422:Materials Testing / Q000379:methods / Q000706:statistics & numerical data*; D010388:Pelvis / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology*; D013123:Spinal Fusion / Q000295:instrumentation*; D013131:Spine / Q000502:physiology*; D013314:Stress, Mechanical; D014057:Tomography, X-Ray Computed