AO Spine Clinical Practice Recommendations: Spinopelvic Fixation - What are the Key Items to Understand Performance?

Study Design: Literature review with clinical recommendations. Objective: To highlight important studies related to spinopelvic fixation and provide recommendations to practicing clinicians on interpretation and utilization of the evidence included in these studies. Methods: Important literature related to spinopelvic fixation was reviewed and clinical recommendations were formulated. Recommendations were graded as strong or conditional. Results: Three articles were selected and reviewed for the strength of methodology and scientific evidence. Article 1: Biomechanical analysis of lumbosacral fixation in Lumbar Fusion and Stabilization was granted conditional recommendation to consider biomechanical factors associated with different pelvic constructs. Article 2: Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation vs traditional iliac fixation was granted strong recommendation to consider risk and benefits in choosing S2AI vs traditional iliac screw for pelvic fixation. Article 3: Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery was granted a conditional recommendation, for taking into account different potential failure mechanisms in S2AI vs traditional iliac screws in pelvic fixation. Conclusions: Currently evolving strategies have included multiple points of pelvic fixation, multiple rods to the pelvis and strategies with concomitant fusion of the sacro-iliac joints. The high mechanical failure rate at the lumbosacral junction indicates that there is still further opportunity for optimization. It is important to consider the risks and benefits of different pelvic fixation methods to optimize the outcomes for individual patients.