Spine · IF 2.6 · August 26, 2026 · LoE III
Reoperation in Long Lumbar Constructs with and Without Iliac Fixation
Kamran Majid, Richard N. Chang, Samear Asefi, Kathryn E. Royse, Jessica Harris, Ravi S. Bains, Ehsan Tabaraee — Colorado Permanente Medical Group
This retrospective registry study compared 483 patients who got iliac screws with 818 who did not during long (>4 level) lumbosacral fusions for degenerative spine disease, following them for a mean of 6.3 years (up to 10 years). After one year, patients with iliac fixation had a lower risk of any reoperation (HR 0.58, 95% CI 0.40-0.85) and a much lower risk of reoperation for nonunion (HR 0.30, 95% CI 0.13-0.67), but there was no difference in reoperation within the first year, for adjacent segment disease, or for hardware failure/removal.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis informs whether spine surgeons should extend fixation to the pelvis in long degenerative lumbar fusions to reduce late nonunion-related reoperation.
Conclusion strengthConfirms prior evidence
The hazard ratio was not converted to an absolute effect because baseline survival at the analysis timepoint was unavailable.
Presenting this at rounds? Start here
- ?Given that the benefit of iliac fixation appears driven almost entirely by reduced nonunion, should surgeons reserve iliac screws for patients at highest risk of pseudarthrosis rather than using them routinely in all long constructs?
- ?Does the finding that unilateral iliac fixation performed as well as bilateral fixation (with fewer implants) support de-escalating to a single iliac screw in appropriate patients?