Spinopelvic fixation.

Fusion to the sacrum presents as a complex and difficult technical procedure with outcomes which have been up until recently, relatively poor, with high pseudoarthrosis rates and associated with the development of so called flat back deformity or loss of lumbar lordosis. Previous reports from the morbidity committee of The Scoliosis Research Society in the late 1970’s indicated that this did not appear to be a problem in adolescence Kostuik et al published, the first results of fusion to the sacrum in adults with idiopathic scoliosis, in 48 cases, using Harrington rods. The pseudoarthrosis rate was 40 percent, there was a flatback deformity rate of 50 percent. Balderston, reported similarly poor results with loss of lordosis in 39 percent, poor results in up to 72 percent, loss of lordosis in 37 percent and 56 percent required additional surgery. The subsequent development of the LuqueGalveston Segmental Instrumentation showed enhanced results. Kostuik in 1988 demonstrated a pseudoarthrosis rate of 15 percent and a flatback deformity rateof 20 percent. Blumenthal, reported further use of Luque-Galveston Segmental Instrumentation as did Boachie, who in, reported a pseudoarthrosis rate of 41 percent, complications of 82 percent and a pain improvement of 63 percent. This is associated with the anterior fusion at the lumbo sacral junction. Saer et al again using the Luque-Galveston techniques, reported a pseudoarthrosis rate of 12 percent which was associated with an anterior column support of the lumbo sacral junction. They reported no flatback deformity. Devlin et al reported in adults requiring fusion to the sacrum, a pseudoarthrosis rate of 26 percent, flatback deformity in 19 percent and instrumentation difficulties of 17 percent in 27 adults. There was no additional anterior column support. Bradford et al at the annual meeting of The Scoliosis Research Society in 2000, reported a 36 percent pseudoarthrosis rate using Luque-Galveston Techniques, seven point five percent with iliac screws and an eight point five percent rate with sacral screws. Kostuik subsequently reported on the use of Cotrel-Dubousset instrumentation, a seven percent pseudoarthrosis rate, a flatback incidence of five percent, also using adjunctive anterior column support. More current results by Kostuik et al, indicate a pseudoarthrosis rate of three percent and a flatback deformity of five percent using more current forms of sacral fixation.