{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:50:55Z","timestamp":1784278255814,"version":"3.55.0"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The objective of this study was to compare a multiple pelvic screw fixation strategy (dual bilateral 4 pelvic screw fixation [4PvS]) with the use of single bilateral 2 pelvic screw fixation (2PvS), with the aim of addressing lumbosacral junction stability.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This analysis is a single-center, retrospective review of ASD patients treated between 2015 and 2021. All patients had a minimum 2-year follow-up and spinal fusion to the sacrum without sacroiliac fusion and met at least one radiographic and procedural criterion: pelvic incidence\u2013lumbar lordosis \u2265 20\u00b0, T1 pelvic angle \u2265 20\u00b0, sagittal vertical axis \u2265 7.5 cm, scoliosis \u2265 50\u00b0, three-column osteotomy, or spinal fusion of \u2265 8 levels. Two sacropelvic fixation methods were compared: 4PvS versus 2PvS. Primary outcomes included spinal implant-related reoperation and screw breakage, while secondary outcomes included reoperation for symptomatic pelvic screws, screw loosening or bending, L5\u2013S1 pseudarthrosis, and patient-reported outcomes. Propensity score matching and inverse probability of treatment weighting (IPTW) were used to minimize selection bias and estimate causal treatment effects. Clinical outcomes were assessed using conditional multivariable logistic regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>In this study of 406 patients (67.98% female, mean age 64.48 years), 349 patients (85.96%) received 2PvS and 57 (14.04%) received 4PvS. Age (OR 1.081, 95% CI 1.027\u20131.145) and total number of osteotomies (OR 1.180, 95% CI 1.048\u20131.355) emerged as independent predictors of receiving the 4PvS technique. In unmatched cohorts (n = 406), 2-year implant-related reoperation rates (p = 0.1896) and pelvic screw breakage rates (p = 0.2498) were not significantly different between groups. However, in the 4:1 propensity score\u2013matched cohort, the 2-year reoperation rate (10.53% for 2PvS vs 3.51% for 4PvS; OR 3.27, 95% CI 1.10\u20139.74 [p = 0.0312]) and the pelvic screw breakage rate (9.21% for 2PvS vs 3.51% for 4PvS; OR 2.87, 95% CI 1.08\u20137.63 [p = 0.0349]) were significantly higher among the 2PvS groups. The IPTW analysis confirmed these findings, with reoperation rates of 10.45% for 2PvS and 1.18% for 4PvS (p = 0.0244) and pelvic screw breakage rates of 8.72% and 1.18%, respectively (p = 0.0477). A safety assessment revealed comparable operative times and intra- and perioperative complications between the two techniques.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Patients who underwent 4PvS demonstrated significantly lower 2-year implant-related reoperation and pelvic screw breakage rates compared with 2PvS, with no differences in intraoperative or perioperative complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.8.spine231331","type":"journal-article","created":{"date-parts":[[2024,12,28]],"date-time":"2024-12-28T02:05:13Z","timestamp":1735351513000},"page":"1-11","source":"Crossref","is-referenced-by-count":5,"title":["Maintaining stability at the lumbosacral-pelvic region in adult spinal deformity surgery without sacroiliac joint fusion: are 4 pelvic screws superior to 2 pelvic screws?"],"prefix":"10.3171","author":[{"given":"Sarthak","family":"Mohanty","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Stephan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Department of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, California;"},{"name":"Department of Orthopaedic Surgery, San Diego Spine Foundation, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Mikhail","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Department of Orthopaedic Surgery, Cedars-Sinai Spine Center, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Platt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Bakhsheshian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"},{"name":"Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fthimnir M.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Lewerenz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan M.","family":"Sardar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald A.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"219","article-title":"Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative","volume":"35","author":"Pichelmann MA","year":"2010","unstructured":"Pichelmann MA, Lenke LG, Bridwell KH, Good CR, O\u2019Leary PT, Sides BA. Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine (Phila Pa 1976). 2010;35(2):219\u2013226."},{"issue":"3","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"382","article-title":"Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures","volume":"32","author":"Martin BI","year":"2007","unstructured":"Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976). 2007;32(3):382\u2013387."},{"issue":"11","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"791","article-title":"Cost-effectiveness of primary and revision surgery for adult spinal deformity","volume":"43","author":"Raman T","year":"2018","unstructured":"Raman T, Nayar SK, Liu S, Skolasky RL, Kebaish KM. 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J Neurosurg Spine. 2015;23(1):67\u201376."},{"issue":"1","key":"b29","series-title":"Neurosurgery","first-page":"67","article-title":"Fate of S2-alar-iliac screws after 12-month minimum radiographic follow-up: preliminary results","volume":"80","author":"Mazur MD","year":"2017","unstructured":"Mazur MD, Mahan MA, Shah LM, Dailey AT. Fate of S2-alar-iliac screws after 12-month minimum radiographic follow-up: preliminary results. Neurosurgery. 2017;80(1):67\u201372."},{"issue":"2","key":"b30","series-title":"J Neurosurg Spine","first-page":"253","article-title":"Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis","volume":"30","author":"De la Garza Ramos R","year":"2018","unstructured":"De la Garza Ramos R, Nakhla J, Sciubba DM, Yassari R. Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis. 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Spine Deform. 2016;4(3):225\u2013229."},{"issue":"7","key":"b33","series-title":"Orthop Surg","first-page":"1457","article-title":"The utilization of dual second sacral alar-iliac screws for spinopelvic fixation in patients with severe kyphoscoliosis","volume":"14","author":"Tang Z","year":"2022","unstructured":"Tang Z, Hu Z, Zhu Z,  The utilization of dual second sacral alar-iliac screws for spinopelvic fixation in patients with severe kyphoscoliosis. Orthop Surg. 2022;14(7):1457\u20131468."},{"key":"b34","series-title":"J Neurosurg Spine","article-title":"Novel method of iliac accessory rods for rod fracture prevention in adult deformity surgery: a case series of 82 patients with outcomes and complications","author":"Berlin C","unstructured":"Berlin C, Ben-Israel D, Sardi JP,  Novel method of iliac accessory rods for rod fracture prevention in adult deformity surgery: a case series of 82 patients with outcomes and complications. J Neurosurg Spine. Published online July 26, 2024. 10.3171\/2024.5.SPINE24208"},{"key":"b35","series-title":"Front Bioeng Biotechnol","first-page":"1148342","article-title":"Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery","volume":"11","author":"Yang H","year":"2023","unstructured":"Yang H, Pan A, Hai Y, Cheng F, Ding H, Liu Y. Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery. Front Bioeng Biotechnol. 2023;11:1148342."},{"issue":"12","key":"b36","series-title":"Eur Spine J","first-page":"2980","article-title":"Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation","volume":"29","author":"Ntilikina Y","year":"2020","unstructured":"Ntilikina Y, Charles YP, Persohn S, Skalli W. Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation. Eur Spine J. 2020;29(12):2980\u20132989."},{"issue":"15","key":"b37","series-title":"Spine (Phila Pa 1976)","first-page":"E925","article-title":"Biomechanical effect of 4-rod technique on lumbosacral fixation: an in vitro human cadaveric investigation","volume":"38","author":"Wang T","year":"2013","unstructured":"Wang T, Liu H, Zheng Z,  Biomechanical effect of 4-rod technique on lumbosacral fixation: an in vitro human cadaveric investigation. Spine (Phila Pa 1976). 2013;38(15):E925\u2013E929."},{"issue":"13","key":"b38","series-title":"Spine (Phila Pa 1976)","first-page":"E400","article-title":"Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction","volume":"33","author":"Kelly BP","year":"2008","unstructured":"Kelly BP, Shen FH, Schwab JS, Arlet V, Diangelo DJ. Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction. Spine (Phila Pa 1976). 2008;33(13):E400\u2013E406."},{"issue":"9","key":"b39","series-title":"Eur Spine J","first-page":"2053","article-title":"Dual iliac screws in spinopelvic fixation: a systematic review","volume":"28","author":"Bourghli A","year":"2019","unstructured":"Bourghli A, Boissiere L, Obeid I. Dual iliac screws in spinopelvic fixation: a systematic review. Eur Spine J. 2019;28(9):2053\u20132059."},{"key":"b40","series-title":"World Neurosurg","first-page":"e300","article-title":"Comparative study of bilateral dual sacral-alar-iliac screws versus bilateral single sacral-alar-iliac screw for adult spine deformities","volume":"156","author":"Uotani K","year":"2021","unstructured":"Uotani K, Tanaka M, Sonawane S,  Comparative study of bilateral dual sacral-alar-iliac screws versus bilateral single sacral-alar-iliac screw for adult spine deformities. World Neurosurg. 2021;156:e300\u2013e306."},{"issue":"6","key":"b41","series-title":"Spine J","first-page":"1121","article-title":"Supplemental rods are needed to maximally reduce rod strain across the lumbosacral junction with TLIF but not ALIF in long constructs","volume":"19","author":"Godzik J","year":"2019","unstructured":"Godzik J, Hlubek RJ, Newcomb AGUS,  Supplemental rods are needed to maximally reduce rod strain across the lumbosacral junction with TLIF but not ALIF in long constructs. 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