The posterior superior iliac rim screw as an adjunct to pelvic fixation in complex spinopelvic stabilization

Abstract

Background: Fixation to the ilium is a commonly used alternative or supplement to sacral fixation in complex spinopelvic reconstructions. This can be achieved with traditional posterior superior iliac spine or S2 alar-iliac screws. Posterior superior iliac rim screws may be considered to achieve or enhance pelvic fixation. The objective of this case series was to describe the use of and indications for posterior superior iliac rim screws.

Methods: A retrospective review was performed of the medical records and radiographic data for three patients who underwent complex lumbosacral reconstructions involving the use of posterior superior iliac rim screws to enhance pelvic fixation. The cases included a 35-year-old with bilateral sacral fractures, a 43-year-old with extensive metastatic sarcoma to the sacrum, and a 48-year-old with multiple lumbar and pelvic fractures. An overview of the key surgical techniques is provided.

Results: All three patients tolerated the procedure, without any unexpected post-operative complications or deficits. Radiographs at last follow-up showed stable fixation and no hardware issues.

Conclusions: The use of posterior superior iliac rim screws as an adjunct method of fixation in complex spinopelvic reconstructions is a feasible option that can be considered in the fixation armamentarium.

Keywords: Complex deformity; Iliac fixation; Pelvic fixation; Posterior iliac screws; Sacral fracture; Spinopelvic reconstruction.