Pelvic Fixation in Spine Surgery by Ali Moshirfar, Frank F. Rand, Paul D. Sponseller, Stephen J. Parazin, A. Jay Khanna, Khaled M. Kebaish, John T. Stinson,

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Presentation transcript:

Pelvic Fixation in Spine Surgery by Ali Moshirfar, Frank F. Rand, Paul D. Sponseller, Stephen J. Parazin, A. Jay Khanna, Khaled M. Kebaish, John T. Stinson, and Lee H. Riley J Bone Joint Surg Am Volume 87(suppl 2): December 1, 2005 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Postoperative lateral radiograph of a patient with scoliosis treated with Harrington instrumentation. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior radiograph of a spine with Luque instrumentation consisting of sublaminar wires and “L” rods. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Schematic posterior coronal view of the zones of sacropelvic fixation as defined by O'Brien36. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

The narrow medial and lateral safe zones for insertion of S1, S2, and alar screws. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

The components of the Tacoma plate system. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Jackson lumbosacral construct. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Model of a lumbosacral and spinopelvic construct with a Kostuik transilial bar. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Paths for insertion of iliac screws within the pelvis. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Exposure of the inner and outer layers of the ilium at the level of the posterior superior iliac spine. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

With a rongeur or chisel, the bone over the posterior superior iliac spine and slightly anterior to it is removed to accommodate the iliac screw head and prevent hardware prominence. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

With a pedicle seeker or a small curet, and under fluoroscopy, the surgeon aims for the anterior inferior iliac spine and taps through the cancellous bone. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

The appropriately sized iliac screw is placed in the same trajectory. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

The iliac screw head must be adequately recessed to prevent hardware prominence. Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.

Ali Moshirfar et al. J Bone Joint Surg Am 2005;87: ©2005 by The Journal of Bone and Joint Surgery, Inc.