Our Summary
This research paper is about a procedure called sacropelvic fixation, which is a type of surgery performed on the lower back and pelvis. This surgery is usually performed when there are serious issues such as spinal fusion, a high-grade displacement of the vertebrae, or severe fractures in the sacrum (the bone at the base of the spine).
The area around the sacrum and pelvis is very complicated and the bone quality is often poor. This makes it very challenging to achieve a solid fusion across the lumbosacral junction (where the lower spine and sacrum meet). However, with a better understanding of how the spine works at this level, surgeons have been able to achieve higher success rates than in the past.
The newer techniques for this procedure are better than the old ones because they secure the bone in front of the pivot point, a technique first described in 1994. The two most popular techniques now are the iliac screws and the S2-alar-iliac screws. While these methods have a high success rate, there can still be issues with pain related to the surgery and the need for additional procedures.
The paper provides an overview of the anatomy and biomechanics of the lumbosacral junction, as well as a summary of the different techniques used for sacropelvic fixation.
FAQs
- What is sacropelvic fixation and when is it indicated?
- What are the two most widely used fixation techniques in sacropelvic fixation today?
- What challenges are faced in achieving solid fusion across the lumbosacral junction?
Doctor’s Tip
One helpful tip a doctor might tell a patient about spinal fusion is to follow the post-operative care instructions carefully, including any restrictions on movement or activities. It is important to give the fusion time to heal properly in order to achieve a successful outcome. Additionally, maintaining a healthy lifestyle with regular exercise and proper nutrition can help support the healing process and overall spine health.
Suitable For
Patients who are typically recommended for spinal fusion include those with:
Degenerative disc disease: Spinal fusion may be recommended for patients with severe degenerative disc disease that has not responded to conservative treatments such as physical therapy or medications.
Scoliosis: Patients with severe scoliosis, a condition characterized by an abnormal curvature of the spine, may be recommended for spinal fusion surgery to correct the curvature and stabilize the spine.
Spinal stenosis: Spinal fusion may be recommended for patients with spinal stenosis, a condition characterized by the narrowing of the spinal canal, to relieve pressure on the spinal cord and nerves.
Spinal fractures: Patients with spinal fractures, such as those resulting from trauma or osteoporosis, may be recommended for spinal fusion surgery to stabilize the spine and promote healing.
Spondylolisthesis: Patients with spondylolisthesis, a condition characterized by the forward displacement of a vertebra, may be recommended for spinal fusion surgery to realign the spine and stabilize the affected vertebrae.
Failed previous spinal surgery: Patients who have had previous spinal surgery that has not been successful may be recommended for spinal fusion surgery to correct the issue and provide stability to the spine.
Overall, the decision to recommend spinal fusion surgery is based on the specific condition of the patient and their individual needs and goals for treatment. It is important for patients to discuss the risks and benefits of spinal fusion with their healthcare provider to determine if it is the right treatment option for them.
Timeline
Before spinal fusion: A patient may have been experiencing chronic back pain, instability, or deformity for a long period of time. They may have tried conservative treatments such as physical therapy, medication, or injections without success. They would have undergone imaging studies such as X-rays, MRI, or CT scans to assess the extent of their spinal condition. A consultation with a spine surgeon would have been scheduled to discuss the possibility of spinal fusion surgery.
During spinal fusion surgery: The patient would be placed under general anesthesia and positioned on their stomach. The surgeon would make an incision in the back to access the spinal column. The damaged or unstable vertebrae would be removed, and bone graft material would be placed in the empty disc space to promote fusion. Metal plates, screws, or rods may be used to stabilize the spine during the healing process.
After spinal fusion surgery: The patient would typically stay in the hospital for a few days for monitoring and pain management. They would gradually start physical therapy to regain strength and mobility. It may take several months for the spine to fully fuse and for the patient to return to normal activities. Follow-up appointments with the surgeon would be scheduled to monitor the healing process and address any concerns or complications. Over time, the patient should experience decreased pain, improved stability, and better overall function in their spine.
What to Ask Your Doctor
- What is the purpose of spinal fusion surgery in my case?
- What are the potential risks and complications associated with spinal fusion surgery?
- What is the success rate of spinal fusion surgery for my specific condition?
- What is the recovery time and rehabilitation process after spinal fusion surgery?
- Will I need physical therapy after spinal fusion surgery?
- How long will I need to take pain medication after spinal fusion surgery?
- What restrictions or limitations will I have after spinal fusion surgery?
- Will I need to have any follow-up appointments or imaging studies after spinal fusion surgery?
- What is the expected outcome and long-term prognosis after spinal fusion surgery?
- Are there any alternative treatment options to spinal fusion surgery that I should consider?
Reference
Authors: El Dafrawy MH, Raad M, Okafor L, Kebaish KM. Journal: Spine Deform. 2019 Jul;7(4):509-516. doi: 10.1016/j.jspd.2018.11.009. PMID: 31202365