Spinopelvic Fixation

What is Spinopelvic Fixation?

Spinopelvic = the region where the spine and the pelvis meet
Fixation = using hardware like screws and rods to immobilize a section of spine

Spinopelvic fixation is a procedure that uses instruments like screws and rods to immobilize the base of the spine. Like other fixation procedures, spinopelvic fixation is performed along with a fusion procedure.

In a fusion, specific bones are encouraged to fuse, or grow together permanently, forming one solid bone. A solid fusion provides stability to the area. Fixation with screws, rods, or other instruments is intended to hold the spine stable while the bones grow together.

Both the lumbar (lower) spine and the sacrum, bottom of the spine, are involved with spinopelvic fixation.

The lumbar spine (along with the thoracic and cervical spine) is made of individual bones called vertebrae that are connected by flexible intervertebral discs.

The sacrum, by contrast, begins as five separate vertebrae at birth. Over the course of childhood and young adulthood, the sacral vertebrae broaden, with the top vertebrae becoming wider than the lower vertebrae. Around puberty, the bones begin to fuse together. By the time a person is in her mid-twenties or early thirties, her sacrum is one solid bone that is roughly triangular in shape.  The sacrum supports the weight of the rest of the spinal column and the trunk of the body, allowing those structures to bend, flex, and rotate.

The sacrum also forms the back wall of the pelvic ring. It is connected by thick, sturdy ligaments to the iliac bones (hip bones) on either side.

When is this Procedure Performed?

A spinopelvic fixation is sometimes required to treat conditions including scoliosis, severe spondylolisthesis, or a tumor that requires bone removal from the lumbar vertebrae or sacrum.

Spinopelvic fixation is sometimes also required when a previous attempt at fusion and fixation requires revision.

Fusion in the lumbosacral area (area between lumbar spine and sacrum) is a particular challenge because of the strong mechanical forces that act on the area. A spinopelvic fixation can help withstand the bending, flexing, and rotation at the lumbosacral joint. This may allow for a successful bone fusion when it has not been possible in the past.

For the best surgical outcome, the surgeon must also consider the spine as a whole. He or she must achieve as much balance as possible, especially in the front-to-back direction. This is called global sagittal balance. Global sagittal balance is an area of special expertise for Dr. Peter Angevine; he regularly teaches courses on the topic to other neurosurgeons.

How is this Procedure Performed?

Spinopelvic fixation is performed under general anesthesia, which means the patient is unconscious.

The patient is positioned face-down to allow the surgeon access to the back of the spine and hip bones. This is called a posterior surgical approach, or an approach from the back of the body.

Long screws are implanted into thick areas of bone in the lumbar spine, sacrum and iliac crest. The heads of the screws are specially designed to be connected with rigid rods. The rods immobilize the joints, and the screws hold the rods in place.

Then the surgeon must perform the bone fusion between the last spinal vertebra and the top of the sacrum. The sturdy sections of bone at the front of the spine are often the site of this fusion. In some cases, the surgeon continue to use a posterior approach (from the back), employing a technique like TLIF or PLIF. In other cases, the surgeon will use an anterior approach (from the front) for the fusion.

How Should I Prepare for this Procedure?

If you smoke or use other tobacco products, speak to your neurosurgeon about quitting. Any form of nicotine interferes with bone fusion, which is necessary for the best surgical outcome.

Make sure you understand the goals of the procedure as well as what you or your child can expect after surgery. Some people find it helpful to write down their questions and bring the list of questions to their appointments.

Make sure to tell your doctor about any medications or supplements that you or the patient are taking, especially medications that can thin the blood such as aspirin. Your doctor may recommend you or the patient stop taking these medications before the procedure. To make it easier, write all the medications down before the day of surgery.

Be sure to tell your doctor if you or the patient have an allergy to any medications, food, or latex (some surgical gloves are made of latex).

On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures. You will be given an ID bracelet. It will include your name, birthdate, and surgeon’s name.

What Can I Expect after the Procedure?

How long will I stay in the hospital?
Hospital stay varies depending on the extent of the surgery.

Will I need to take any special medications?
Postsurgical discomfort will be controlled with pain medication.

Will I need to wear a brace?
Typically patients do not need to wear a brace, but in some cases, a brace may be prescribed.

When can I resume exercise?
Walking can begin immediately. More vigorous exercise should be postponed until later.

Will I need rehabilitation or physical therapy?
Yes, patients typically begin a physical therapy program after they have healed from surgery.

Will I have any long-term limitations due to this procedure?
Patients with spinopelvic fixation may notice some limitation in mobility, which sometimes manifests as difficulty running or tying shoes. If these limitations are bothersome, iliac fixation may in some cases be removed after fusion is solid. This is usually two years or more after surgery.

Preparing for Your Appointment

At the Spine Hospital at the Neurological Institute of New York, Drs. Michael G. Kaiser, Peter D. AngevineChristopher E. Mandigo and Alexander Tuchman are experts in spinopelvic fixation. Dr. Richard C. E. Anderson (Pediatric) specializes in pediatric spinopelvic fixation.

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