Abstract
Spinopelvic dissociation is a highly unstable orthopedic injury with a growing incidence worldwide. Operative treatment classically involves an open lumbopelvic fusion and sacroiliac stabilization, which carries high perioperative morbidity and mortality in a frail patient population. Advancements in spinal navigation, robotics, and minimally invasive surgery (MIS) techniques now allow these fracture patterns to be treated entirely percutaneously through small incisions. These incisions are just large enough to accommodate pedicle screw guides and enable the placement of lumbopelvic instrumentation, with rods being passed subfascially across pedicle screws and extending caudally to iliac fixation. This contrasts with the open midline approach, which requires more extensive soft tissue dissection and results in increased blood loss compared to percutaneous techniques. Modern imaging techniques, including CT navigation and robotics, facilitate the precise placement of sacral S2AI screw instrumentation in both open and percutaneous methods, all while safely avoiding previously placed trans-sacral fixation and other existing hardware, such as acetabular screws. Trans-sacral screws are typically percutaneously inserted first by the orthopedic trauma service, utilizing inlet, outlet, and lateral sacral fluoroscopic guidance to navigate the limited available corridor. With the advent of MIS techniques, trauma patients can now benefit from faster postoperative rehabilitation, minimal blood loss, decreased pain, and quicker mobilization. This article will review current concepts on spinopelvic anatomy, fracture patterns, indications for treatment, and current concepts for minimally invasive percutaneous lumbopelvic fixation, and it will present illustrative examples.