{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:32Z","timestamp":1780736492190,"version":"3.54.1"},"reference-count":34,"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":"\n OBJECTIVE<\/jats:title>\n The purpose of this study was to evaluate the risks and benefits of removing painful pelvic\/iliac screws in spine fusion surgery patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective review identified patients who had traditional iliac and S2-alar-iliac (S2AI) screws removed for pain. The minimum follow-up was 24 months.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Fifty-two patients (75% women) were included with a mean age of 63 years, BMI of 28, and follow-up of 65 months. Most of the removed screws were S2AI (83%) compared with traditional iliac screws (17%). Forty-three patients (83%) had improvement in their pelvic screw related\u2013pain following removal. Eight patients (15%) experienced lumbosacral mechanical complications following pelvic screw removal including sacral fracture (n = 3, 6%) and\/or L4\u20135 or L5\u2013S1 rod fracture (n = 7, 13%). On multivariable analysis, risk factors for mechanical complications following pelvic screw removal included a longer fusion construct (OR 1.34, p = 0.035), greater postoperative L4\u2013S1 lordosis (OR 1.14, p = 0.04, ideal cutoff > 40\u00b0), and lack of bone morphogenetic protein (BMP; OR 0.03, p = 0.02). Ten patients (19%) underwent subsequent SI joint fusion following pelvic screw removal, and higher standing pelvic incidence (OR 1.10, p = 0.03) was the only independent predictor of SI fusion.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Removal of painful pelvic screws resulted in a high rate of postoperative pain relief, albeit with a risk of lumbosacral mechanical complications and subsequent SI joint fusion. Patients at risk for lumbosacral mechanical complications following pelvic screw removal included those with longer fusion constructs, more lordosis from L4 to S1 (> 40\u00b0), and lack of BMP. Patients at risk for receiving an instrumented SI joint fusion following pelvic screw removal included those with a higher pelvic incidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.3.focus2510","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T05:55:18Z","timestamp":1748757318000},"page":"E15","source":"Crossref","is-referenced-by-count":0,"title":["Removal of painful pelvic screws following spine fusion surgery: outcomes and complications"],"prefix":"10.3171","volume":"58","author":[{"given":"Anthony L.","family":"Mikula","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Lakomkin","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Martini","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman M.","family":"Hamouda","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nassr","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Freedman","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun S.","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William W.","family":"Cross","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy L.","family":"Fogelson","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"389","article-title":"Sacropelvic fixation: when, why, how?","volume":"29","author":"Lombardi JM","year":"2018","unstructured":"Lombardi JM, Shillingford JN, Lenke LG, Lehman RA. Sacropelvic fixation: when, why, how?. Neurosurg Clin N Am. 2018;29(3):389\u2013397."},{"issue":"2","key":"b2","series-title":"Orthop Clin North Am","first-page":"371","article-title":"Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum","volume":"19","author":"Kostuik JP","year":"1988","unstructured":"Kostuik JP. Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum. Orthop Clin North Am. 1988;19(2):371\u2013381."},{"issue":"18","key":"b3","series-title":"J Bone Joint Surg Am","first-page":"1521","article-title":"Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS Exhibit Selection","volume":"97","author":"Jain A","year":"2015","unstructured":"Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM. Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS Exhibit Selection. J Bone Joint Surg Am. 2015;97(18):1521\u20131528."},{"issue":"18","key":"b4","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 TR","year":"2001","unstructured":"Kuklo TR, Bridwell KH, Lewis SJ, Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976). 2001;26(18):1976\u20131983."},{"issue":"8","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"824","article-title":"Fusion to the sacrum for nonparalytic scoliosis in the adult","volume":"11","author":"Balderston RA","year":"1986","unstructured":"Balderston RA, Winter RB, Moe JH, Bradford DS, Lonstein JE. Fusion to the sacrum for nonparalytic scoliosis in the adult. Spine (Phila Pa 1976). 1986;11(8):824\u2013829."},{"issue":"25","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"2245","article-title":"Sacropelvic fixation: techniques and complications","volume":"35","author":"Kebaish KM","year":"2010","unstructured":"Kebaish KM. Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976). 2010;35(25):2245\u20132251."},{"issue":"3","key":"b7","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 K","year":"2006","unstructured":"Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976). 2006;31(3):303\u2013308."},{"issue":"13","key":"b8","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\u2019Shaughnessy BA","year":"2012","unstructured":"O\u2019Shaughnessy 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":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"436","article-title":"Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation","volume":"34","author":"Chang TL","year":"2009","unstructured":"Chang TL, Sponseller PD, Kebaish KM, Fishman EK. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976). 2009;34(5):436\u2013440."},{"issue":"4","key":"b10","series-title":"Neurospine","first-page":"1469","article-title":"Sacropelvic fixation for adult deformity surgery comparing iliac screw and sacral 2 alar-iliac screw fixation: systematic review and updated meta-analysis","volume":"20","author":"Shin HK","year":"2023","unstructured":"Shin HK, Park JH, Jeon SR, Sacropelvic fixation for adult deformity surgery comparing iliac screw and sacral 2 alar-iliac screw fixation: systematic review and updated meta-analysis. Neurospine. 2023;20(4):1469\u20131476."},{"issue":"11","key":"b11","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063."},{"issue":"1","key":"b12","series-title":"J Neurosurg Spine","first-page":"50","article-title":"Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes","volume":"32","author":"Mikula AL","year":"2020","unstructured":"Mikula AL, Puffer RC, Jeor JDS, Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes. J Neurosurg Spine. 2020;32(1):50\u201355."},{"key":"b13","series-title":"World Neurosurg","first-page":"e530","article-title":"Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients","volume":"117","author":"Daniels AH","year":"2018","unstructured":"Daniels AH, DePasse JM, Durand W, Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients. World Neurosurg. 2018;117:e530\u2013e537."},{"issue":"1","key":"b14","series-title":"J Neurosurg Spine","first-page":"86","article-title":"Bilateral open sacroiliac joint fusion during adult spinal deformity surgery using triangular titanium implants: technique description and presentation of 21 cases","volume":"36","author":"Martin CT","year":"2022","unstructured":"Martin CT, Holton KJ, Jones KE, Sembrano JN, Polly DW. Bilateral open sacroiliac joint fusion during adult spinal deformity surgery using triangular titanium implants: technique description and presentation of 21 cases. J Neurosurg Spine. 2022;36(1):86\u201392."},{"key":"b15","series-title":"World Neurosurg","first-page":"e15","article-title":"Randomized trial of augmented pelvic fixation in patients undergoing thoracolumbar fusion for adult spine deformity: initial results from a multicenter randomized trial","volume":"187","author":"Polly D","year":"2024","unstructured":"Polly D, Mundis G, Eastlack R, Randomized trial of augmented pelvic fixation in patients undergoing thoracolumbar fusion for adult spine deformity: initial results from a multicenter randomized trial. World Neurosurg. 2024;187:e15\u2013e27."},{"issue":"4","key":"b16","series-title":"J Neurosurg Spine","first-page":"617","article-title":"Change in pelvic incidence between the supine and standing positions in patients with bilateral sacroiliac joint vacuum signs","volume":"34","author":"Mikula AL","year":"2021","unstructured":"Mikula AL, Fogelson JL, Oushy S, Change in pelvic incidence between the supine and standing positions in patients with bilateral sacroiliac joint vacuum signs. J Neurosurg Spine. 2021;34(4):617\u2013622."},{"issue":"1","key":"b17","series-title":"J Neurosurg Spine","first-page":"42","article-title":"Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution","volume":"36","author":"de Andrada Pereira B","year":"2022","unstructured":"de Andrada Pereira B, Wangsawatwong P, Lehrman JN, Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution. J Neurosurg Spine. 2022;36(1):42\u201352."},{"issue":"3","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"389","article-title":"Sacropelvic fixation: when, why, how?","volume":"29","author":"Lombardi JM","year":"2018","unstructured":"Lombardi JM, Shillingford JN, Lenke LG, Lehman RA. Sacropelvic fixation: when, why, how?. Neurosurg Clin N Am. 2018;29(3):389\u2013397."},{"issue":"2","key":"b2","series-title":"Orthop Clin North Am","first-page":"371","article-title":"Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum","volume":"19","author":"Kostuik JP","year":"1988","unstructured":"Kostuik JP. Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum. Orthop Clin North Am. 1988;19(2):371\u2013381."},{"issue":"18","key":"b3","series-title":"J Bone Joint Surg Am","first-page":"1521","article-title":"Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS Exhibit Selection","volume":"97","author":"Jain A","year":"2015","unstructured":"Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM. Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS Exhibit Selection. J Bone Joint Surg Am. 2015;97(18):1521\u20131528."},{"issue":"18","key":"b4","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 TR","year":"2001","unstructured":"Kuklo TR, Bridwell KH, Lewis SJ, Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976). 2001;26(18):1976\u20131983."},{"issue":"8","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"824","article-title":"Fusion to the sacrum for nonparalytic scoliosis in the adult","volume":"11","author":"Balderston RA","year":"1986","unstructured":"Balderston RA, Winter RB, Moe JH, Bradford DS, Lonstein JE. Fusion to the sacrum for nonparalytic scoliosis in the adult. Spine (Phila Pa 1976). 1986;11(8):824\u2013829."},{"issue":"25","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"2245","article-title":"Sacropelvic fixation: techniques and complications","volume":"35","author":"Kebaish KM","year":"2010","unstructured":"Kebaish KM. Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976). 2010;35(25):2245\u20132251."},{"issue":"3","key":"b7","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 K","year":"2006","unstructured":"Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976). 2006;31(3):303\u2013308."},{"issue":"13","key":"b8","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\u2019Shaughnessy BA","year":"2012","unstructured":"O\u2019Shaughnessy 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":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"436","article-title":"Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation","volume":"34","author":"Chang TL","year":"2009","unstructured":"Chang TL, Sponseller PD, Kebaish KM, Fishman EK. Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976). 2009;34(5):436\u2013440."},{"issue":"4","key":"b10","series-title":"Neurospine","first-page":"1469","article-title":"Sacropelvic fixation for adult deformity surgery comparing iliac screw and sacral 2 alar-iliac screw fixation: systematic review and updated meta-analysis","volume":"20","author":"Shin HK","year":"2023","unstructured":"Shin HK, Park JH, Jeon SR, Sacropelvic fixation for adult deformity surgery comparing iliac screw and sacral 2 alar-iliac screw fixation: systematic review and updated meta-analysis. Neurospine. 2023;20(4):1469\u20131476."},{"issue":"11","key":"b11","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063."},{"issue":"1","key":"b12","series-title":"J Neurosurg Spine","first-page":"50","article-title":"Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes","volume":"32","author":"Mikula AL","year":"2020","unstructured":"Mikula AL, Puffer RC, Jeor JDS, Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes. J Neurosurg Spine. 2020;32(1):50\u201355."},{"key":"b13","series-title":"World Neurosurg","first-page":"e530","article-title":"Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients","volume":"117","author":"Daniels AH","year":"2018","unstructured":"Daniels AH, DePasse JM, Durand W, Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients. World Neurosurg. 2018;117:e530\u2013e537."},{"issue":"1","key":"b14","series-title":"J Neurosurg Spine","first-page":"86","article-title":"Bilateral open sacroiliac joint fusion during adult spinal deformity surgery using triangular titanium implants: technique description and presentation of 21 cases","volume":"36","author":"Martin CT","year":"2022","unstructured":"Martin CT, Holton KJ, Jones KE, Sembrano JN, Polly DW. Bilateral open sacroiliac joint fusion during adult spinal deformity surgery using triangular titanium implants: technique description and presentation of 21 cases. J Neurosurg Spine. 2022;36(1):86\u201392."},{"key":"b15","series-title":"World Neurosurg","first-page":"e15","article-title":"Randomized trial of augmented pelvic fixation in patients undergoing thoracolumbar fusion for adult spine deformity: initial results from a multicenter randomized trial","volume":"187","author":"Polly D","year":"2024","unstructured":"Polly D, Mundis G, Eastlack R, Randomized trial of augmented pelvic fixation in patients undergoing thoracolumbar fusion for adult spine deformity: initial results from a multicenter randomized trial. World Neurosurg. 2024;187:e15\u2013e27."},{"issue":"4","key":"b16","series-title":"J Neurosurg Spine","first-page":"617","article-title":"Change in pelvic incidence between the supine and standing positions in patients with bilateral sacroiliac joint vacuum signs","volume":"34","author":"Mikula AL","year":"2021","unstructured":"Mikula AL, Fogelson JL, Oushy S, Change in pelvic incidence between the supine and standing positions in patients with bilateral sacroiliac joint vacuum signs. J Neurosurg Spine. 2021;34(4):617\u2013622."},{"issue":"1","key":"b17","series-title":"J Neurosurg Spine","first-page":"42","article-title":"Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution","volume":"36","author":"de Andrada Pereira B","year":"2022","unstructured":"de Andrada Pereira B, Wangsawatwong P, Lehrman JN, Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution. J Neurosurg Spine. 2022;36(1):42\u201352."}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/6\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/6\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/6\/article-pE15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:25:19Z","timestamp":1780734319000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/6\/article-pE15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,1]]},"references-count":34,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.3.focus2510","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,1]]}}}