{
  "abstract": "Background:: The purpose of this study was to determine whether placement of triangular titanium implants (TTI) suprajacent to S2-alar-iliac (S2AI) pelvic fixation screws during multilevel spinal fusion surgery for adult spine deformity reduces pelvic fixation failures.\n\nMethods:: This prospective, multicenter, international, partially blinded randomized clinical trial included 222 patients scheduled for multilevel spinal fusion surgery with S2AI-based pelvic fixation. In the S2AI+TTI group, the mean age was 64.9 years, 54.1% were female, 3.7% were Hispanic, 5.5% were African American, and 1.8% were Asian. In the S2AI-alone group, the mean age was 64.8 years, 58.4% were female, 3.5% were Hispanic, 7.1% were African American, and 0.9% were Asian. Subjects were randomized to pelvic fixation using S2AI screws alone versus S2AI+TTI. Scheduled follow-up included a 24-month full-spine radiograph and a high-resolution computed tomography (CT) scan, which was independently interpreted.\n\nResults:: The primary composite radiographic end point (S2AI screw breakage, lucency, or pullout, or posterior spinal rod breakage distal to S1) occurred less frequently in the S2AI+TTI group than in the S2AI-alone group (11.0% versus 20.4%, p = 0.0415). Except for rod-screw dissociation and rod fracture distal to S1, all components of the primary composite end point occurred less frequently in the S2AI+TTI group. TTI placement did not affect sagittal or coronal spinal alignment parameters. The rate of rod fracture throughout the spinal construct was slightly higher in the S2AI+TTI group (9.2% versus 5.3%) but the difference was not significant (p = 0.197).\n\nConclusions:: Placement of TTI suprajacent to S2AI screws reduced the rate of pelvic fixation failure in patients undergoing multilevel spinal fusion with pelvic fixation.\n\nLevel of Evidence:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.",
  "abstract_shown": true,
  "affiliations": [
    "Mayo Clinic, Rochester, Minnesota",
    "San Diego Spine Foundation, San Diego, California",
    "ASST-Ovest Milanese, Legnano, Lombardy, Italy",
    "Klinikum Magdeburg, Magdeburg, Germany",
    "Royal National Orthopaedic Hospital, Stanmore, United Kingdom",
    "University of Minnesota, Minneapolis, Minnesota"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
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        0
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      "name": "Benjamin D. Elder",
      "orcid": "0000-0002-7782-7829"
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    {
      "affs": [
        1
      ],
      "name": "Gregory Mundis",
      "orcid": "0000-0002-1483-7245"
    },
    {
      "affs": [
        1
      ],
      "name": "Robert Eastlack"
    },
    {
      "affs": [
        2
      ],
      "name": "Paolo Arrigoni",
      "orcid": "0000-0002-9056-7275"
    },
    {
      "affs": [
        3
      ],
      "name": "Joerg Franke",
      "orcid": "0009-0002-7289-8510"
    },
    {
      "affs": [
        4
      ],
      "name": "Robert Lee"
    },
    {
      "affs": [
        5
      ],
      "name": "David Polly",
      "orcid": "0000-0001-7572-6584"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5w44cwqs6pa4j.bib",
  "cited_by": 0,
  "doi": "10.2106/jbjs.25.01415",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13712662/",
  "id": "5w44cwqs6pa4j",
  "issns": [
    "0021-9355",
    "1535-1386"
  ],
  "landing_url": "https://doi.org/10.2106/jbjs.25.01415",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "0150"
    ],
    [
      "heading",
      "Randomized Controlled Trials"
    ],
    [
      "heading",
      "Scientific Articles"
    ],
    [
      "openalex",
      "2746|Scoliosis diagnosis and treatment"
    ]
  ],
  "openalex": "W7168492734",
  "pdf_url": null,
  "pmcid": "PMC13712662",
  "pmid": "42462059",
  "published": "2026-07-16",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5w44cwqs6pa4j.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:23:11Z",
      "native_id": "PMC13712662",
      "source": "pmc",
      "url": "https://doi.org/10.2106/jbjs.25.01415"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Scoliosis diagnosis and treatment",
      "subfield": "surgery"
    }
  ],
  "title": "Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion",
  "title_text": "Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:23:11Z",
  "url": "https://research.draconitic.com/paper/5w44cwqs6pa4j",
  "venue": "The Journal of Bone and Joint Surgery. American Volume",
  "versions": []
}