Spinopelvic fixation in deformity: a review.

Spinopelvic fixation techniques are evolving and now seem to be converging. Good S1 pedicle fixation is the initial key anchor point. The tricortical technique tests out as the best. Supplemental fixation options are available. The most efficacious seems to be iliac fixation, followed by two-level structural interbody support. Achieving appropriate global sagittal balance also lessens the likelihood of implant pullout and places the fusion mass under relatively more compressive forces than tension forces. Regardless of the method of fixation, the ultimate determinant of long-term implant survival is the achievement of adequate biologic fusion.