Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion: Results of a Randomized Controlled Trial.
Benjamin D Elder, Gregory Mundis, Robert Eastlack et al.
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In 30 seconds
This prospective, multicentre, international, partially blinded randomised trial tested whether triangular titanium implants (TTI) placed above S2-alar-iliac (S2AI) screws reduce pelvic fixation failure during multilevel spinal fusion for adult spinal deformity. Among 222 patients, the 24-month composite radiographic endpoint—S2AI screw breakage, lucency or pullout, or rod breakage distal to S1—occurred in 11.0% with S2AI+TTI versus 20.4% with S2AI alone (p = 0.0415). TTI placement did not affect spinal alignment parameters. The authors concluded that adding TTI reduced pelvic fixation failure.
Key findings
- The primary composite radiographic endpoint occurred in 11.0% with S2AI+TTI versus 20.4% with S2AI alone (p = 0.0415).
- Except for rod-screw dissociation and rod fracture distal to S1, each component of the composite endpoint occurred less often with TTI.
- Rod fracture across the full spinal construct was 9.2% with TTI versus 5.3% without TTI; the difference was not significant (p = 0.197).
- TTI placement did not affect sagittal or coronal spinal alignment parameters.
Why it matters
Pelvic fixation failure is a relevant radiographic outcome in multilevel spinal fusion. In this randomised trial, adding TTI to S2AI fixation reduced the composite failure endpoint, providing comparative evidence for this construct in the studied population. The findings also distinguish pelvic fixation outcomes from rod fracture across the full construct, for which no significant difference was reported.
What to keep in mind
The reported primary outcome was a composite radiographic endpoint assessed at 24 months; the abstract does not report longer-term outcomes.