Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion
6 affiliations
- 1Mayo Clinic, Rochester, Minnesota
- 2San Diego Spine Foundation, San Diego, California
- 3ASST-Ovest Milanese, Legnano, Lombardy, Italy
- 4Klinikum Magdeburg, Magdeburg, Germany
- 5Royal National Orthopaedic Hospital, Stanmore, United Kingdom
- 6University of Minnesota, Minneapolis, Minnesota
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.
Methods:: 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.
Results:: 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).
Conclusions:: Placement of TTI suprajacent to S2AI screws reduced the rate of pelvic fixation failure in patients undergoing multilevel spinal fusion with pelvic fixation.
Level of Evidence:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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BibTeX
@article{elder2026placement,
title = {{Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion}},
author = {Benjamin D. Elder and Gregory Mundis and Robert Eastlack and Paolo Arrigoni and Joerg Franke and Robert Lee and David Polly},
journal = {The Journal of Bone and Joint Surgery. American Volume},
year = {2026},
month = jul,
doi = {10.2106/jbjs.25.01415},
url = {https://doi.org/10.2106/jbjs.25.01415},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion
AU - Benjamin D. Elder
AU - Gregory Mundis
AU - Robert Eastlack
AU - Paolo Arrigoni
AU - Joerg Franke
AU - Robert Lee
AU - David Polly
PY - 2026
DA - 2026/07/16
JO - The Journal of Bone and Joint Surgery. American Volume
DO - 10.2106/jbjs.25.01415
UR - https://doi.org/10.2106/jbjs.25.01415
AB - 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. Methods:: 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. Results:: 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). Conclusions:: Placement of TTI suprajacent to S2AI screws reduced the rate of pelvic fixation failure in patients undergoing multilevel spinal fusion with pelvic fixation. Level of Evidence:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
SN - 0021-9355
SN - 1535-1386
ER -