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Pelvic screws were assessed on follow-up post-operative standing radiographs for evidence of loosening. Surgical revision of spinal instrumentation served as the primary outcome. PROMIS Pain Interference and Physical Function T-Scores were assessed as secondary outcomes among the subset of cases (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200992) with available scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pelvic screw loosening was appreciated in 25 cases (16.4%) with initial evidence of loosening identified a median 1.1\u00a0years (Q1: 0.8, Q3: 2.5) following surgery. Loosening of pelvic screws (OR 3.0, 95% CI 1.2\u20137.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.017) was associated with significantly increased odds of eventual instrumentation revision surgery, including specifically surgical revision of spinopelvic fixation (OR 5.5, 95% CI 1.6\u201318.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.006). 4 of 26 cases (15%) with S2-Alar-Iliac (S2AI) screws required revision surgery compared to 37 of 126 cases (29%) without S2AI screws. PROMIS T-Scores were significantly worse for patients requiring instrumentation revision surgery but did not differ between cases with and without loosening.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Loosening of spinopelvic fixation occurs frequently following correction of ASD and can develop years following surgery. While distal construct screw loosening may be appreciated incidentally at follow-up, loosening of pelvic screws was associated with significantly increased odds of eventual instrumentation revision surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01281-6","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:04:56Z","timestamp":1781579096000},"page":"1661-1669","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and outcomes of spinopelvic fixation loosening following adult spinal deformity surgery"],"prefix":"10.1007","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4322-4472","authenticated-orcid":false,"given":"John D.","family":"Arena","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohannes","family":"Ghenbot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5201-6720","authenticated-orcid":false,"given":"Mert Marcel","family":"Dagli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua L.","family":"Golubovsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addison","family":"Quinones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3924-6687","authenticated-orcid":false,"given":"Dominick","family":"Macaluso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil R.","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9048-0487","authenticated-orcid":false,"given":"Zarina S.","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4981-1408","authenticated-orcid":false,"given":"Brendan F.","family":"Judy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang W.","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1665-7985","authenticated-orcid":false,"given":"William C.","family":"Welch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Arlet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7490-8108","authenticated-orcid":false,"given":"John H.","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"issue":"3","key":"1281_CR1","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/BRS.0000000000001202","volume":"41","author":"S Bess","year":"2016","unstructured":"Bess S et al (2016) The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. 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Otherwise, the authors have no competing interests to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approval for this retrospective study was provided by the Institutional Review Board of the University of Pennsylvania (Protocol number 848854).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}