Extract
Fusions of the lumbosacral spine continue to be a challenging area
in spine surgery. The complex local anatomy, unique biomechanical forces, and
poor bone quality of the sacrum are just a few of the many reasons why fusions
of the lumbosacral spine have been notoriously difficult to perform.The goals of this review were (1) to familiarize the reader with the
complicated anatomy of the lumbosacral region, the specific pathological
entities that involve this region, and the biomechanical forces that lead to
high pseudarthrosis rates; (2) to discuss the various types of lumbosacral and
spinopelvic implants and their respective advantages and disadvantages; (3) to
review the most common clinical indications for lumbosacral and spinopelvic
fusions; and (4) to emphasize that iliac screw placement is a safe and
reproducible technique for achieving stable caudad pelvic fixation that
minimizes the risk of pseudarthrosis at the lumbosacral junction.