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Fusion to Sacrum

- Discussion:
    - in adults, a two-stage anterior and posterior procedure is performed;
    - w/ this technique, rate of pseudarthrosis is < 5 %;
    - CD instrumentation:
            - another advantage of this instrumentation is improved fixation to sacrum, w/ pedicular screws used instead of Harrington hooks or 
                   Luque rods;
- Myelomenigocele:
    - arthrodesis to pelvis is often needed to correct severe pelvic obliquity and dysraphism;
    - in pts w/ high-level myelomeningocele, it is important to fuse to sacrum if the curve is major and cannot be corrected below 15 deg;
    - in child w/ low lumbar myelomeningocele who is able to walk, a fusion to sacrum will impair walking ability & confine child to wheelchair;
    - sacrum is not be fused in walking child unless absolutely necessary

Fusion to the sacrum for nonparalytic scoliosis in the adult.

Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum.

The Galveston experience with L-rod instrumentation for adolescent idiopathic scoliosis.