Work

Pelvic fixation in short construct lumbo-sacral fusions with a novel porous ingrowth implant: results from a prospective, multicenter, observational study

Year: 2026

Type: article

Abstract: Background: The indications for pelvic fixation (PF) in short constructs are unclear. This subgroup analysis of the prospective, multicenter, observational Pelvic Fixation and Fusion During Multilevel Spine Surgery (PAULA) clinical study aimed to better define common indications and early outcomes of PF in short-segment lumbar fusions (two to three treated levels) using a novel porous-ingrowth implant. Methods: This was a prospective, multicenter, pragmatic observational study with minimal eligibility criteria to ensure generalizability in the real-world setting. Patients who underwent short-segment lumbar fusion of three or fewer levels to the pelvis with at least 6 months of follow-up were included in this analysis. Indications and outcomes of PF were recorded. Results: , respectively. The upper instrumented vertebra (UIV) was L3 in 65.6% of cases and L4 in 34.4%. Surgeons listed multiple indications for PF in each case. Osteoporosis was the most frequently selected indication for PF, accounting for 20.5% of the total 83 indications recorded across the 32 patients (n=17), followed by pseudarthrosis (16.9%, n=14) and spondylolisthesis (15.7%, n=13). The mean (SD) Oswestry Disability Index (ODI) improved from 49.6 (18.2) at baseline to 35.6 (20.9) at 12 months. Mean numerical rating scale (NRS) back pain improved from 7.2 (2.8) at baseline to 3.6 (3.2) at 12 months. There were no instances of S1 or pelvic implant failure and no complications attributable to PF at 6- or 12-month follow-up. Conclusions: PF using a porous-ingrowth implant was feasible as an adjunct in short-segment constructs in this small, single-arm study, and may be particularly applicable in patients with osteoporosis or in revision cases indicated for pseudarthrosis. Further studies are needed to establish appropriate clinical indications and comparative safety.

Source: Journal of Spine Surgery

DOI: 10.21037/jss-2026-0211