Linville, Douglas A II a; Dmitriev, Anton E b Abstract: Purpose of review: Provide summary of recent advances in lumbosacral fixation as it applies to short- and long-segment arthrodesis. Recent findings: Iliac screw fixation appears in clinical and in-vitro studies to be the most secure fixation that is available across the lumbosacral joint. This type of fixation should include bilateral segmental fixation at L5 and S1 if possible, and is indicated for long instrumented fusions from L3 or above. Debate continues when to include L5-S1 in adult spinal deformity fusion surgery. Despite better correction of sagittal deformity and prevention of lumbosacral degenerative changes, instrumentation to the sacrum and pelvis appears to have more complications and reoperations without documented benefit on outcomes. Summary: For short fusions without destabilizing reduction or resection, single or two-level constructs with or without interbody arthrodesis appear satisfactory. For spinal deformity or revision surgery requiring fusion to the sacrum and extending above L3, it is advised to protect the distal point of fixation. Based on the biomechanical data, iliac screw fixation provides the greatest level of stability to the lumbosacral junction. Interbody fusion alone will not reduce strain on sacral screws to the degree that other distal fixation points will. However, supplemental interbody arthrodesis is highly recommended for cases of sagittal imbalance, pseudoarthrosis, or long arthrodesis across the sacrum in spinal deformity cases.
Current Opinion in Orthopedics. 16(3):137-143, June 2005.