{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:36:39Z","timestamp":1777944999845,"version":"3.51.4"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,5]]},"abstract":"\n Object<\/jats:title>\n Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5\u2013S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5\u2013S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39\u201379 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5\u2013S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.3.focus1428","type":"journal-article","created":{"date-parts":[[2014,5,1]],"date-time":"2014-05-01T06:54:41Z","timestamp":1398927281000},"page":"E10","source":"Crossref","is-referenced-by-count":19,"title":["Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?"],"prefix":"10.3171","volume":"36","author":[{"given":"Rajiv","family":"Saigal","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darryl","family":"Lau","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishi","family":"Wadhwa","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai","family":"Le","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morsi","family":"Khashan","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigurd","family":"Berven","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-0360010","series-title":"Programs and Abstracts of the 40th Annual Meeting of the Scoliosis Research Society, Miami, Florida, 2005","first-page":"52","article-title":"Complications and 2 to 10 year results of long fusions to the sacrum and pelvis for adult deformity: is bilateral iliac fixation necessary?","author":"Breakwell","year":"2005"},{"key":"b2-0360010","series-title":"J Neurosurg Spine","first-page":"445","article-title":"Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors. Clinical article","volume":"19","author":"Cho","year":"2013"},{"key":"b3-0360010","series-title":"World Neurosurg","article-title":"Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications","author":"Fu","year":"2013"},{"key":"b4-0360010","series-title":"J Neurosurg Spine","first-page":"95","article-title":"Sexual function in older adults following thoracolumbar to pelvic instrumentation for spinal deformity. Clinical article","volume":"19","author":"Hamilton","year":"2013"},{"key":"b5-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"489","article-title":"Spinal fusions to the sacrum in adults with scoliosis","volume":"8","author":"Kostuik","year":"1983"},{"key":"b6-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"1721","article-title":"Biomechanical testing of the lumbosacral spine","volume":"23","author":"Kostuik","year":"1998"},{"key":"b7-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"1976","article-title":"Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws","volume":"26","author":"Kuklo","year":"2001"},{"key":"b8-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"2312","article-title":"Biomechanical comparison of lumbosacral fixation techniques in a calf spine model","volume":"27","author":"Lebwohl","year":"2002"},{"key":"b9-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"574","article-title":"Lumbosacral spinal fusion. A biomechanical study","volume":"9","author":"Lee","year":"1984"},{"issue":"8 Suppl","key":"b10-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"S235","article-title":"Biomechanical analysis of lumbosacral fixation","volume":"17","author":"McCord","year":"1992"},{"issue":"Suppl 2","key":"b11-0360010","series-title":"J Bone Joint Surg Am","first-page":"89","article-title":"Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques","volume":"87","author":"Moshirfar","year":"2005"},{"issue":"Suppl 2","key":"b12-0360010","series-title":"Eur Spine J","first-page":"S265","article-title":"Pelvic fixation for adult scoliosis","volume":"22","author":"Shen","year":"2013"},{"key":"b13-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"2127","article-title":"Unilateral and bilateral sacropelvic fixation result in similar construct biomechanics","volume":"33","author":"Tomlinson","year":"2008"},{"key":"b14-0360010","series-title":"Spine (Phila Pa 1976)","first-page":"303","article-title":"Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity","volume":"31","author":"Tsuchiya","year":"2006"},{"issue":"3 Suppl","key":"b15-0360010","series-title":"Neurosurgery","first-page":"183","article-title":"Long-segment spinal fixation using pelvic screws","volume":"63","author":"Tumial\u00e1n","year":"2008"},{"issue":"2","key":"b16-0360010","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Percutaneous iliac screw placement: description of a new minimally invasive technique","volume":"25","author":"Wang","year":"2008"},{"key":"b17-0360010","series-title":"J Spinal Disord Tech","article-title":"Minimally invasive percutaneous iliac screws: initial 24 case experience with CT confirmation","author":"Wang","year":"2012"},{"key":"b1-0360010","series-title":"Programs and Abstracts of the 40th Annual Meeting of the Scoliosis Research Society, Miami, Florida, 2005","first-page":"52","article-title":"Complications and 2 to 10 year results of long fusions to the sacrum and pelvis for adult deformity: is bilateral iliac fixation necessary?","author":"Breakwell","year":"2005"},{"key":"b2-0360010","series-title":"J Neurosurg Spine","first-page":"445","article-title":"Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors. 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