title: The flying buttress construct for posterior spinopelvic fixation: a technical note.
abstract: BACKGROUND
  Posterior fusion of the spine to the pelvis in paediatric and adult spinal deformity is still challenging. Especially assembling of the posterior rod construct to the iliac screw is considered technically difficult. A variety of spinopelvic fixation techniques have been developed. However, extreme bending of the longitudinal rods or the use of 90-degree lateral offset connectors proved to be difficult, because the angle between the rod and the iliac screw varies from patient to patient.
  
  
  METHODS
  We adopted a new spinopelvic fixation system, in which iliac screws are side-to-side connected to the posterior thoracolumbar rod construct, independent of the angle between the rod and the iliac screw. Open angled parallel connectors are used to connect short iliac rods from the posterior rod construct to the iliac screws at both sides. The construct resembles in form and function an architectural Flying Buttress, or lateral support arches, used in Gothic cathedrals.
  
  
  CONCLUSIONS
  Three different cases that illustrate the Flying Buttress construct for spinopelvic fixation are reported here with the clinical details, radiographic findings and surgical technique used.
  
  
  CONCLUSIONS
  The Flying Buttress construct may offer an alternative surgical option for spinopelvic fixation in circumstances wherein coronal or sagittal balance cannot be achieved, for example in cases with significant residual pelvic obliquity, or in revision spinal surgery for failed lumbosacral fusion.
authors.affiliation: Department of Orthopaedic Surgery VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. bj.vanroyen@vumc.nl.
authors.forename: Barend J
authors.initials: BJ
authors.lastname: van Royen
authors.forename: Martijn
authors.initials: M
authors.lastname: van Dijk
authors.forename: Dirk Ph
authors.initials: DP
authors.lastname: van Oostveen
authors.forename: Bas
authors.initials: B
authors.lastname: van Ooij
authors.forename: Agnita
authors.initials: A
authors.lastname: Stadhouder