{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:57:38Z","timestamp":1784937458682,"version":"3.55.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>While traditional literature in adult spinal deformity (ASD) examining mechanical complications has focused on proximal junctional kyphosis and failure, distal junctional failure (DJF) of constructs ending at the sacrum with or without spinopelvic fixation remains less explored. The current study sought to 1) propose a new DJF classification with a panel of experienced deformity surgeons, and 2) analyze intra- and interreliability of the novel classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A prior review study was completed that identified all types of distal complications for lumbosacral fusions. A panel of 25 experienced spinal deformity surgeons used a modified Delphi approach with three rounds of review to create a classification system. Ten deformity surgeons then reviewed a representative series of 14 de-identified cases to assess the interrater reliability of the classification system using the intraclass correlation coefficient (ICC). A second round of review was conducted by each investigator to determine intrarater reliability using Cohen\u2019s kappa coefficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Complications were classified as acute (&lt; 90 days from the date of surgery) or chronic (\u2265 3 months from the date of surgery). Acute failures included mechanical failure of the screws or screw-rod interface, such as pelvic set plug dissociation, tulip head dissociation, and fracture of the pelvic screw at any point along its trajectory. Fractures of the rod (proximal vs distal to S1) and distal bony anatomy (sacrum vs pelvis) were included, as was failure of the offset connector. Chronic failures also consisted of pseudarthrosis at distal levels, sacroiliac joint (SIJ) pain, screw halo formation, and painful screw prominence. The intrarater and interrater reliability were both high with Cohen\u2019s kappa of 0.91 and an ICC of 0.98, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These data provide a comprehensive and systematic classification scheme of distal complications following long-segment ASD fusion to the sacrum. This new paradigm will allow for more detailed and consistent reporting of distal junctional complications following spinopelvic fusion, with or without supplemental pelvic fixation and\/or concomitant SIJ fusion. This classification scheme resulted in high intra- and interrater reliability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.focus24969","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T05:55:16Z","timestamp":1748757316000},"page":"E14","source":"Crossref","is-referenced-by-count":5,"title":["Distal junctional failure following pelvic instrumentation in spinal fusion: a novel classification system"],"prefix":"10.3171","volume":"58","author":[{"given":"Benjamin D.","family":"Elder","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Lakomkin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K.","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Scripps Clinic, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Leveque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virginia Mason Medical Center, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Essig","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwell Health, Great Neck, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Lord","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohaib Z.","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Northwell Health, Great Neck, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Polly","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Semin Spine Surg","first-page":"101060","article-title":"Evolving concepts in pelvic fixation in adult spinal deformity surgery","volume":"35","author":"Turner JD","year":"2023","unstructured":"Turner JD, Schupper AJ, Mummaneni PV,  Evolving concepts in pelvic fixation in adult spinal deformity surgery. Semin Spine Surg. 2023;35(4):101060."},{"issue":"6","key":"b2","series-title":"Spine J","first-page":"964","article-title":"Postoperative complications of S2AI versus iliac screw in spinopelvic fixation: a meta-analysis and recent trends review","volume":"20","author":"Hasan MY","year":"2020","unstructured":"Hasan MY, Liu G, Wong HK, Tan JH. Postoperative complications of S2AI versus iliac screw in spinopelvic fixation: a meta-analysis and recent trends review. Spine J. 2020;20(6):964\u2013972."},{"issue":"6","key":"b3","series-title":"Global Spine J","first-page":"514","article-title":"Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity","volume":"7","author":"Merrill RK","year":"2017","unstructured":"Merrill RK, Kim JS, Leven DM, Kim JH, Cho SK. Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity. Global Spine J. 2017;7(6):514\u2013520."},{"issue":"3 Suppl","key":"b4","series-title":"Neurosurgery","first-page":"183","article-title":"Long-segment spinal fixation using pelvic screws","volume":"63","author":"Tumial\u00e1n LM","year":"2008","unstructured":"Tumial\u00e1n LM, Mummaneni PV. Long-segment spinal fixation using pelvic screws. Neurosurgery. 2008;63(3 Suppl):183-190."},{"issue":"3","key":"b5","series-title":"Bone Jt Open","first-page":"19","article-title":"Incidence of spinal deformity surgery in a national health service from 2005 to 2018","volume":"1","author":"Tsirikos AI","year":"2020","unstructured":"Tsirikos AI, Roberts SB, Bhatti E. Incidence of spinal deformity surgery in a national health service from 2005 to 2018. Bone Jt Open. 2020;1(3):19\u201328."},{"issue":"1","key":"b6","series-title":"J Craniovertebr Junction Spine","first-page":"17","article-title":"Complications of adult spinal deformity surgery: a literature review","volume":"13","author":"Ak\u0131nt\u00fcrk N","year":"2022","unstructured":"Ak\u0131nt\u00fcrk N, Zileli M, Yaman O. Complications of adult spinal deformity surgery: a literature review. J Craniovertebr Junction Spine. 2022;13(1):17\u201326."},{"issue":"5","key":"b7","series-title":"JBJS Rev","first-page":"e0214","article-title":"Complications of thoracolumbar adult spinal deformity surgery","volume":"8","author":"Patel SA","year":"2020","unstructured":"Patel SA, McDonald CL, Reid DBC, DiSilvestro KJ, Daniels AH, Rihn JA. Complications of thoracolumbar adult spinal deformity surgery. JBJS Rev. 2020;8(5):e0214."},{"issue":"11","key":"b8","series-title":"Spine J","first-page":"1784","article-title":"Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations","volume":"21","author":"Lakomkin N","year":"2021","unstructured":"Lakomkin N, Stannard B, Fogelson JL, Mikula AL, Lenke LG, Zuckerman SL. Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations. Spine J. 2021;21(11):1784\u20131792."},{"issue":"4","key":"b9","series-title":"Semin Spine Surg","first-page":"100992","article-title":"Proximal junctional kyphosis in adult spinal deformity: an up-to-date review","volume":"34","author":"Alhammoud A","year":"2022","unstructured":"Alhammoud A, Korytkowski PD, Lavelle WF, Metkar US. Proximal junctional kyphosis in adult spinal deformity: an up-to-date review. Semin Spine Surg. 2022;34(4):100992."},{"issue":"14","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"986","article-title":"Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery","volume":"47","author":"Eastlack RK","year":"2022","unstructured":"Eastlack RK, Soroceanu A, Mundis GM,  Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery. Spine (Phila Pa 1976). 2022;47(14):986\u2013994."},{"issue":"7","key":"b11","series-title":"Eur Spine J","first-page":"2751","article-title":"Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis","volume":"33","author":"Odland K","year":"2024","unstructured":"Odland K, Chanbour H, Zuckerman SL, Polly DW. Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis. Eur Spine J. 2024;33(7):2751-2762"},{"issue":"2","key":"b12","series-title":"J Neurosurg Spine","first-page":"208","article-title":"Incidence, mechanism, and protective strategies for 2-year pelvic fixation failure after adult spinal deformity surgery with a minimum six-level fusion","volume":"38","author":"Lee NJ","year":"2023","unstructured":"Lee NJ, Marciano G, Puvanesarajah V,  Incidence, mechanism, and protective strategies for 2-year pelvic fixation failure after adult spinal deformity surgery with a minimum six-level fusion. J Neurosurg Spine. 2023;38(2):208\u2013216."},{"issue":"6","key":"b13","series-title":"Medicina (Kaunas)","first-page":"1149","article-title":"Establishing a standardized clinical consensus for reporting complications following lateral lumbar interbody fusion","volume":"59","author":"Mundis GM","year":"2023","unstructured":"Mundis GM, Ito K, Lakomkin N,  Establishing a standardized clinical consensus for reporting complications following lateral lumbar interbody fusion. Medicina (Kaunas). 2023;59(6):1149."},{"issue":"Suppl 1","key":"b14","series-title":"Int J Spine Surg","first-page":"20","article-title":"Minimally invasive sacroiliac joint fusion: the current evidence","volume":"14","author":"Martin CT","year":"2020","unstructured":"Martin CT, Haase L, Lender PA, Polly DW. Minimally invasive sacroiliac joint fusion: the current evidence. Int J Spine Surg. 2020;14(Suppl 1):20-29."},{"issue":"6","key":"b15","series-title":"J Orthop Sci","first-page":"926","article-title":"Rod fracture after long construct fusion for spinal deformity: clinical and radiographic risk factors","volume":"18","author":"Akazawa T","year":"2013","unstructured":"Akazawa T, Kotani T, Sakuma T, Nemoto T, Minami S. Rod fracture after long construct fusion for spinal deformity: clinical and radiographic risk factors. J Orthop Sci. 2013;18(6):926\u2013931."},{"key":"b16","series-title":"Scoliosis","first-page":"30","article-title":"Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series","volume":"10","author":"Barton C","year":"2015","unstructured":"Barton C, Noshchenko A, Patel V, Cain C, Kleck C, Burger E. Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series. Scoliosis. 2015;1030."},{"issue":"6","key":"b17","series-title":"J Neurosurg Spine","first-page":"994","article-title":"Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity","volume":"21","author":"Smith JS","year":"2014","unstructured":"Smith JS, Shaffrey E, Klineberg E,  Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014;21(6):994\u20131003."},{"issue":"6","key":"b18","series-title":"Spine J","first-page":"1409","article-title":"Outrigger rod technique for supplemental support of posterior spinal arthrodesis","volume":"15","author":"Palumbo MA","year":"2015","unstructured":"Palumbo MA, Shah KN, Eberson CP, Hart RA, Daniels AH. Outrigger rod technique for supplemental support of posterior spinal arthrodesis. Spine J. 2015;15(6):1409\u20131414."},{"issue":"2","key":"b19","series-title":"J Neurosurg Spine","first-page":"217","article-title":"Rod fractures in thoracolumbar fusions to the sacrum\/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients","volume":"38","author":"Sardi JP","year":"2023","unstructured":"Sardi JP, Lazaro B, Smith JS,  Rod fractures in thoracolumbar fusions to the sacrum\/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients. J Neurosurg Spine. 2023;38(2):217\u2013229."},{"issue":"1","key":"b20","series-title":"J Orthop Trauma","first-page":"22","article-title":"Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads","volume":"17","author":"Schildhauer TA","year":"2003","unstructured":"Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt MLC. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17(1):22\u201331."},{"issue":"2","key":"b21","series-title":"J Neurosurg Spine","first-page":"225","article-title":"Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm","volume":"33","author":"Buell TJ","year":"2020","unstructured":"Buell TJ, Yener U, Wang TR,  Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm. J Neurosurg Spine. 2020;33(2):225\u2013236."},{"issue":"1","key":"b22","series-title":"J Neurosurg Spine","first-page":"98","article-title":"Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors","volume":"38","author":"Martin CT","year":"2023","unstructured":"Martin CT, Holton KJ, Elder BD,  Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors. J Neurosurg Spine. 2023;38(1):98\u2013106."},{"issue":"8","key":"b23","series-title":"Global Spine J","first-page":"1640","article-title":"Minimum 2-year analysis of s2-alar-iliac screw fixation for adult spinal deformity","volume":"12","author":"Ha AS","year":"2022","unstructured":"Ha AS, Hong DY, Luzzi AJ,  Minimum 2-year analysis of s2-alar-iliac screw fixation for adult spinal deformity. Global Spine J. 2022;12(8):1640\u20131646."},{"issue":"13","key":"b24","series-title":"Spine (Phila Pa 1976)","first-page":"1175","article-title":"Should symptomatic iliac screws be electively removed in adult spinal deformity patients fused to the sacrum?","volume":"37","author":"O'Shaughnessy BA","year":"2012","unstructured":"O'Shaughnessy BA, Lenke LG, Bridwell KH,  Should symptomatic iliac screws be electively removed in adult spinal deformity patients fused to the sacrum?. Spine (Phila Pa 1976). 2012;37(13):1175\u20131181."},{"issue":"5","key":"b25","series-title":"Spine (Phila Pa 1976)","first-page":"E162","article-title":"Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study","volume":"34","author":"Ivanov AA","year":"2009","unstructured":"Ivanov AA, Kiapour A, Ebraheim NA, Goel V. Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study. Spine (Phila Pa 1976). 2009;34(5):E162\u2013169."},{"issue":"12","key":"b26","series-title":"Spine (Phila Pa 1976)","first-page":"999","article-title":"Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion","volume":"41","author":"Unoki E","year":"2016","unstructured":"Unoki E, Abe E, Murai H, Kobayashi T, Abe T. Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion. Spine (Phila Pa 1976). 2016;41(12):999\u20131005."},{"issue":"4","key":"b1","series-title":"Semin Spine Surg","first-page":"101060","article-title":"Evolving concepts in pelvic fixation in adult spinal deformity surgery","volume":"35","author":"Turner JD","year":"2023","unstructured":"Turner JD, Schupper AJ, Mummaneni PV,  Evolving concepts in pelvic fixation in adult spinal deformity surgery. Semin Spine Surg. 2023;35(4):101060."},{"issue":"6","key":"b2","series-title":"Spine J","first-page":"964","article-title":"Postoperative complications of S2AI versus iliac screw in spinopelvic fixation: a meta-analysis and recent trends review","volume":"20","author":"Hasan MY","year":"2020","unstructured":"Hasan MY, Liu G, Wong HK, Tan JH. Postoperative complications of S2AI versus iliac screw in spinopelvic fixation: a meta-analysis and recent trends review. Spine J. 2020;20(6):964\u2013972."},{"issue":"6","key":"b3","series-title":"Global Spine J","first-page":"514","article-title":"Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity","volume":"7","author":"Merrill RK","year":"2017","unstructured":"Merrill RK, Kim JS, Leven DM, Kim JH, Cho SK. Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity. Global Spine J. 2017;7(6):514\u2013520."},{"issue":"3 Suppl","key":"b4","series-title":"Neurosurgery","first-page":"183","article-title":"Long-segment spinal fixation using pelvic screws","volume":"63","author":"Tumial\u00e1n LM","year":"2008","unstructured":"Tumial\u00e1n LM, Mummaneni PV. Long-segment spinal fixation using pelvic screws. Neurosurgery. 2008;63(3 Suppl):183-190."},{"issue":"3","key":"b5","series-title":"Bone Jt Open","first-page":"19","article-title":"Incidence of spinal deformity surgery in a national health service from 2005 to 2018","volume":"1","author":"Tsirikos AI","year":"2020","unstructured":"Tsirikos AI, Roberts SB, Bhatti E. Incidence of spinal deformity surgery in a national health service from 2005 to 2018. Bone Jt Open. 2020;1(3):19\u201328."},{"issue":"1","key":"b6","series-title":"J Craniovertebr Junction Spine","first-page":"17","article-title":"Complications of adult spinal deformity surgery: a literature review","volume":"13","author":"Ak\u0131nt\u00fcrk N","year":"2022","unstructured":"Ak\u0131nt\u00fcrk N, Zileli M, Yaman O. Complications of adult spinal deformity surgery: a literature review. J Craniovertebr Junction Spine. 2022;13(1):17\u201326."},{"issue":"5","key":"b7","series-title":"JBJS Rev","first-page":"e0214","article-title":"Complications of thoracolumbar adult spinal deformity surgery","volume":"8","author":"Patel SA","year":"2020","unstructured":"Patel SA, McDonald CL, Reid DBC, DiSilvestro KJ, Daniels AH, Rihn JA. Complications of thoracolumbar adult spinal deformity surgery. JBJS Rev. 2020;8(5):e0214."},{"issue":"11","key":"b8","series-title":"Spine J","first-page":"1784","article-title":"Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations","volume":"21","author":"Lakomkin N","year":"2021","unstructured":"Lakomkin N, Stannard B, Fogelson JL, Mikula AL, Lenke LG, Zuckerman SL. Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations. Spine J. 2021;21(11):1784\u20131792."},{"issue":"4","key":"b9","series-title":"Semin Spine Surg","first-page":"100992","article-title":"Proximal junctional kyphosis in adult spinal deformity: an up-to-date review","volume":"34","author":"Alhammoud A","year":"2022","unstructured":"Alhammoud A, Korytkowski PD, Lavelle WF, Metkar US. Proximal junctional kyphosis in adult spinal deformity: an up-to-date review. Semin Spine Surg. 2022;34(4):100992."},{"issue":"14","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"986","article-title":"Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery","volume":"47","author":"Eastlack RK","year":"2022","unstructured":"Eastlack RK, Soroceanu A, Mundis GM,  Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery. Spine (Phila Pa 1976). 2022;47(14):986\u2013994."},{"issue":"7","key":"b11","series-title":"Eur Spine J","first-page":"2751","article-title":"Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis","volume":"33","author":"Odland K","year":"2024","unstructured":"Odland K, Chanbour H, Zuckerman SL, Polly DW. Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis. Eur Spine J. 2024;33(7):2751-2762"},{"issue":"2","key":"b12","series-title":"J Neurosurg Spine","first-page":"208","article-title":"Incidence, mechanism, and protective strategies for 2-year pelvic fixation failure after adult spinal deformity surgery with a minimum six-level fusion","volume":"38","author":"Lee NJ","year":"2023","unstructured":"Lee NJ, Marciano G, Puvanesarajah V,  Incidence, mechanism, and protective strategies for 2-year pelvic fixation failure after adult spinal deformity surgery with a minimum six-level fusion. J Neurosurg Spine. 2023;38(2):208\u2013216."},{"issue":"6","key":"b13","series-title":"Medicina (Kaunas)","first-page":"1149","article-title":"Establishing a standardized clinical consensus for reporting complications following lateral lumbar interbody fusion","volume":"59","author":"Mundis GM","year":"2023","unstructured":"Mundis GM, Ito K, Lakomkin N,  Establishing a standardized clinical consensus for reporting complications following lateral lumbar interbody fusion. Medicina (Kaunas). 2023;59(6):1149."},{"issue":"Suppl 1","key":"b14","series-title":"Int J Spine Surg","first-page":"20","article-title":"Minimally invasive sacroiliac joint fusion: the current evidence","volume":"14","author":"Martin CT","year":"2020","unstructured":"Martin CT, Haase L, Lender PA, Polly DW. Minimally invasive sacroiliac joint fusion: the current evidence. Int J Spine Surg. 2020;14(Suppl 1):20-29."},{"issue":"6","key":"b15","series-title":"J Orthop Sci","first-page":"926","article-title":"Rod fracture after long construct fusion for spinal deformity: clinical and radiographic risk factors","volume":"18","author":"Akazawa T","year":"2013","unstructured":"Akazawa T, Kotani T, Sakuma T, Nemoto T, Minami S. Rod fracture after long construct fusion for spinal deformity: clinical and radiographic risk factors. J Orthop Sci. 2013;18(6):926\u2013931."},{"key":"b16","series-title":"Scoliosis","first-page":"30","article-title":"Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series","volume":"10","author":"Barton C","year":"2015","unstructured":"Barton C, Noshchenko A, Patel V, Cain C, Kleck C, Burger E. Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series. Scoliosis. 2015;1030."},{"issue":"6","key":"b17","series-title":"J Neurosurg Spine","first-page":"994","article-title":"Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity","volume":"21","author":"Smith JS","year":"2014","unstructured":"Smith JS, Shaffrey E, Klineberg E,  Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014;21(6):994\u20131003."},{"issue":"6","key":"b18","series-title":"Spine J","first-page":"1409","article-title":"Outrigger rod technique for supplemental support of posterior spinal arthrodesis","volume":"15","author":"Palumbo MA","year":"2015","unstructured":"Palumbo MA, Shah KN, Eberson CP, Hart RA, Daniels AH. Outrigger rod technique for supplemental support of posterior spinal arthrodesis. Spine J. 2015;15(6):1409\u20131414."},{"issue":"2","key":"b19","series-title":"J Neurosurg Spine","first-page":"217","article-title":"Rod fractures in thoracolumbar fusions to the sacrum\/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients","volume":"38","author":"Sardi JP","year":"2023","unstructured":"Sardi JP, Lazaro B, Smith JS,  Rod fractures in thoracolumbar fusions to the sacrum\/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients. J Neurosurg Spine. 2023;38(2):217\u2013229."},{"issue":"1","key":"b20","series-title":"J Orthop Trauma","first-page":"22","article-title":"Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads","volume":"17","author":"Schildhauer TA","year":"2003","unstructured":"Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt MLC. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17(1):22\u201331."},{"issue":"2","key":"b21","series-title":"J Neurosurg Spine","first-page":"225","article-title":"Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm","volume":"33","author":"Buell TJ","year":"2020","unstructured":"Buell TJ, Yener U, Wang TR,  Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm. J Neurosurg Spine. 2020;33(2):225\u2013236."},{"issue":"1","key":"b22","series-title":"J Neurosurg Spine","first-page":"98","article-title":"Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors","volume":"38","author":"Martin CT","year":"2023","unstructured":"Martin CT, Holton KJ, Elder BD,  Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors. J Neurosurg Spine. 2023;38(1):98\u2013106."},{"issue":"8","key":"b23","series-title":"Global Spine J","first-page":"1640","article-title":"Minimum 2-year analysis of s2-alar-iliac screw fixation for adult spinal deformity","volume":"12","author":"Ha AS","year":"2022","unstructured":"Ha AS, Hong DY, Luzzi AJ,  Minimum 2-year analysis of s2-alar-iliac screw fixation for adult spinal deformity. 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