title: Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.
abstract: Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish: editorialservices@jhmi.edu.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish: editorialservices@jhmi.edu.
authors.forename: Sophia A
authors.initials: SA
authors.lastname: Strike
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish: editorialservices@jhmi.edu.
authors.forename: Emmanuel N
authors.initials: EN
authors.lastname: Menga
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish: editorialservices@jhmi.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish: editorialservices@jhmi.edu.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000266:history / Q000379:methods*; D002648:Child; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D015601:Injury Severity Score; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000266:history / Q000379:methods*