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Open Access Methodology

The flying buttress construct for posterior spinopelvic fixation: a technical note

Barend J van Royen1*, Martijn van Dijk2, Dirk PH van Oostveen1, Bas van Ooij1 and Agnita Stadhouder1

Author Affiliations

1 Department of Orthopaedic Surgery VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

2 Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

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Scoliosis 2011, 6:6  doi:10.1186/1748-7161-6-6

Published: 13 April 2011

Abstract

Background

Posterior fusion of the spine to the pelvis in paediatric and adult spinal deformity is still challenging. Especially assembling of the posterior rod construct to the iliac screw is considered technically difficult. A variety of spinopelvic fixation techniques have been developed. However, extreme bending of the longitudinal rods or the use of 90-degree lateral offset connectors proved to be difficult, because the angle between the rod and the iliac screw varies from patient to patient.

Methods

We adopted a new spinopelvic fixation system, in which iliac screws are side-to-side connected to the posterior thoracolumbar rod construct, independent of the angle between the rod and the iliac screw. Open angled parallel connectors are used to connect short iliac rods from the posterior rod construct to the iliac screws at both sides. The construct resembles in form and function an architectural Flying Buttress, or lateral support arches, used in Gothic cathedrals.

Results and discussion

Three different cases that illustrate the Flying Buttress construct for spinopelvic fixation are reported here with the clinical details, radiographic findings and surgical technique used.

Conclusion

The Flying Buttress construct may offer an alternative surgical option for spinopelvic fixation in circumstances wherein coronal or sagittal balance cannot be achieved, for example in cases with significant residual pelvic obliquity, or in revision spinal surgery for failed lumbosacral fusion.