Spinopelvic fixation

Spinopelvic fixation is a procedure which uses spinal instrumentation such as screws and rods to stabilize the spine in cases of fractures in the spinopelvic region. It is considered as a rigid fixation method for unstable fractures in this region and is generally performed along with a fusion procedure. The lumbar spine and the sacrum are both involved in spinopelvic fixation.  

The sacrum is a bony structure which is located at the base of the lumbar vertebrae and is attached to the pelvis. It supports the weight of the spinal column, withstands vertical forces and allows for flexion and rotation. Spinopelvic fixation supports spinal stability and bony union without the loss of segmental correction. Recent minimally invasive approaches for spinopelvic fixation have reduced the risk of infection and increased the rate of bony union. 

Indications of Indications of spinopelvic fixation

Spinopelvic fixation may be indicated in the following conditions:

• Long-segment lumbar and thoracolumbar fusions to the sacrum 
• High grade lumbosacral spondylolisthesis 
• Unstable pelvic ring fractures 
• Neoplasms, infections and fractures of the sacrum 
• Osteoporotic and traumatic fractures 
• Long segment fusions for spinal deformity 
• Failure of previous fusion and fixation procedures 
• Tumors requiring bone removal in the lumbar vertebrae of sacrum 

Spinopelvic fixation procedure  

Spinopelvic fixation is a procedure which is performed under general anesthesia. The patient is in a prone position facing downwards for the surgeon to access the back of the spine. This is known as the posterior approach. Then, the surgeon selects entry points for the screws based on intersection of specific anatomical borders.  

Next, screws of suitable length and diameter are inserted into thick bony areas in the lumbar spine, sacrum and iliac crest (bone that forms the pelvis). Then, connecting rods are inserted and attached to the screws. Finally, bony fusion is performed between the final spinal vertebrae and top portion of the sacrum. Internal fixation is confirmed through radiographic imagine and the wound is closed. 

Recovery 

Mild postsurgical discomfort may be experienced. This is controlled with pain medications. Hospital stay may depend on the extent of the surgery and all patients are recommended to undergo respiratory physiotherapy to prevent pulmonary complications. Patients will be provided instructions on assisted bed mobility and upper extremity exercises by preventing excessive load on the pelvic region.