What is Spinopelvic Fixation?
Spinopelvic refers to the area where the pelvis and spine meet. Fixation refers to utilization of fixation devices such as rods and screws to immobilize a part of the spine and allow healing.
Spinopelvic fixation is a surgical procedure in which the base of the spine is immobilized using rods and screws and accompanied by a fusion procedure. A fusion encourages specific bones to grow together or fuse permanently to form one solid bone. A solid fusion bestows stability to the region. Fixation devices function by holding the spine stable as the bones grow together.
A spinopelvic fixation procedure involves both the lumbar (lower) spine and the sacrum (base of the spine).
Anatomy of the Lumbosacral Spine
The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. The vertebrae are protected by spongy vertebral discs that are present in between them and are supported by ligaments that hold them together and surround the underlying spinal cord. The spine can be divided into 4 parts: cervical, thoracic, lumbar, and sacral region. The lumbar spine is composed of the lower 5 vertebrae, numbered L1–L5. The lowest vertebra of the lumbar spine (L5) is connected to the top of the sacrum, which is a triangular bone present at the base of the spine that fits into the two pelvic bones.
Indications for Spinopelvic Fixation Surgery
Lumbosacral dissociation is the main indication for spinopelvic fixation. Lumbosacral dissociation is a high-energy traumatic injury that results in anatomic separation of the vertebral column from the pelvis and is most often associated with neurological deficits as well as other fractures. Fractures of the sacrum also result in spinopelvic dissociation or instability. Spinopelvic fixation helps to achieve complete exclusion of the fractured sacrum from weight-bearing and restore stability to an unstable pelvis. It is recommended for the treatment of conditions such as:
- Scoliotic spine degeneration
- Degenerative spondylolisthesis or spinal stenosis
- Infection of the pelvic joints and bones
- Resection of pelvic tumors requiring bone removal from the sacrum or lumbar vertebrae
- Revision failed fusion and fixation surgery
Preparation for Spinopelvic Fixation Surgery
Pre-procedure preparation for spinopelvic fixation may involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You will be instructed to shower with an antibacterial soap the morning of surgery to help lower your risk of infection after surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Spinopelvic Fixation Surgery
The basic steps involved in the spinopelvic fixation surgery include:
- The procedure will be performed through a posterior approach from the back of the body.
- You will be administered general anesthesia and placed in a prone position (face down) on the operating table.
- A vertical incision is made over the sacrum and muscles and soft tissues are retracted to expose the lumbosacral area.
- Your surgeon performs the required treatment such as removal of a tumor or bony fragments from the fracture zone.
- Long screws are inserted into sturdy sections of bone in the iliac crest, sacrum, and lumbar spine.
- The screw heads are specifically designed to be fixed with rigid rods.
- The rods work by immobilizing the joints and the screws hold the rods firmly in place.
- Your surgeon then performs bone fusion between the top of the sacrum (S1) and the last spinal vertebra (L5).
- The thick sections of bone at the anterior of the spine are commonly the location of this fusion.
- Confirmatory X-rays may be taken to confirm proper alignment as well as fixation and fusion at the lumbosacral area.
- Finally, the retracted muscles and soft tissues are placed in their normal anatomical positions and the incision is sutured.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after spinopelvic fixation surgery may involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital for 2 to 3 days before discharge to home.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the low back area is also recommended to reduce inflammation and pain.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Your diet is slowly advanced post surgery. You will start with clear liquids, then progress to having normal solid foods, as tolerated.
- Instructions on surgical site care and bathing will be provided.
- Eating a high-calcium and low-fat diet is strongly recommended to promote healing and a faster recovery.
- Avoid lifting, bending, or twisting your back for the first 6 weeks. Do not lift anything heavier than 5 pounds for the first 2 weeks. Refrain from any strenuous activities such as housework, yard work, or sex for at least a month.
- A corset or brace may be recommended to limit bending and assist with healing of the fused region.
- A physical therapy protocol is recommended to help strengthen low back, pelvic, and leg muscles and optimize their function. Walking is a good exercise and is strongly recommended to improve your endurance.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- You will be able to resume your normal activities in 2 to 3 weeks but may have certain activity restrictions.
- Complete recovery and return to work vary from patient to patient as it is related to a patient’s overall health status and the type of work one does.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Spinopelvic fixation surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood clots
- Anesthetic reactions
- Hardware failure
- Neurovascular injury
- Persistent pain
- Failure of vertebral fusion