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What is the difference between fused to the sacrum and fused to the pelvis?

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  • What is the difference between fused to the sacrum and fused to the pelvis?

    In humans, the sacrum (plural: sacrums or sacra) is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx (tailbone). It consists of usually five initially unfused vertebrae which begin to fuse between ages 16–18 and are usually completely fused into a single bone by age 34.

    It is curved upon itself and placed obliquely (that is, tilted forward). It is kyphotic — that is, concave facing forwards. The base projects forward as the sacral promontory internally, and articulates with the last lumbar vertebra to form the prominent sacrovertebral angle. The central part is curved outward towards the posterior, allowing greater room for the pelvic cavity. The two lateral projections of the sacrum are called ala (wings), and articulate with the ilium at the L-shaped sacroiliac joints.


    The above quote comes from wikipedia. It shows a picture of the sacrum as part of the pelvis. I tried to copy the picture to the blog, but pictures don't copy.

    So, what is the difference of fusion to the PELVIS vs fusion to the SACRUM? Can you have fixation in the sacrum like you have in the pelvis?
    Call me confused....Susan
    Last edited by susancook; 01-09-2013, 10:26 PM. Reason: Poor typist ;+[
    Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
    2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw
    2021: Removal T1 screw & rod

  • #2
    Hi Susan,

    fusion to the sacrum almost always includes pelvic fixation, which means that the rods and screws go all the way down to the sacrum, with an additional long screw extending across one or both sacroiliac joints into the ilium. Pelvic fixation is done to protect against fracture of the sacrum due to the pressure/stress transmitted down through the newly-fused area of the spine, while the fusion is healing.

    Functionally there would be no difference at all in mobility or lack thereof between fusion to the sacrum only and fusion with pelvic fixation. Only problem with the iliac screws is that sometimes they can be a source of pain. I have read that there are newer techniques now to try and prevent pain from the iliac screws. Nonetheless, some people do suffer pain or discomfort from them. Some people, myself included, go on to have the iliac screw(s) removed after one or two years time due to pain. Apparently once fusion has occurred, the iliac screws are no longer needed.

    I am glad that you had such a good consult with Dr Hu, and I hope you are finding your peace.

    Take care,
    Last edited by leahdragonfly; 01-09-2013, 10:53 PM.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

    Comment


    • #3
      Originally posted by leahdragonfly View Post
      Hi Susan,

      fusion to the sacrum almost always includes pelvic fixation, which means that the rods and screws go all the way down to the sacrum, with an additional long screw extending across one or both sacroiliac joints into the ilium. Pelvic fixation is done to protect against fracture of the sacrum due to the pressure/stress transmitted down through the newly-fused area of the spine, while the fusion is healing.

      Functionally there would be no difference at all in mobility or lack thereof between fusion to the sacrum only and fusion with pelvic fixation. Only problem with the iliac screws is that sometimes they can be a source of pain. I have read that there are newer techniques now to try and prevent pain from the iliac screws. Nonetheless, some people do suffer pain or discomfort from them. Some people, myself included, go on to have the iliac screw(s) removed after one or two years time due to pain. Apparently once fusion has occurred, the iliac screws are no longer needed.

      You can visit my care page at www.carepages.com/GayleKalman . You have to create a free carepages account and password, then you can view my photo album. I have my x-rays posted which clearly show the iliac screw extending into the left ilium. The right side did not receive an iliac screw. You can see the difference between the right and left sides on my post-op x-rays. There is also a photo of the large iliac screw once it was removed during my revision for broken rods.

      I am glad that you had such a good consult with Dr Hu, and I hope you are finding your peace.

      Take care,
      Thanks, Gayle! You have been supportive from the beginning of my journey when I had my first appointment and we talked in the waiting room. My Gratitude, Susan
      Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

      2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
      2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
      2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
      2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
      2018: Removal L4,5 screw
      2021: Removal T1 screw & rod

      Comment


      • #4
        Gayle,

        Did you have to have new iliac screws with your revision, and will they be removed?

        Also, how could you be sure it was the iliac screws causing discomfort?

        Also, why does the risk of fracture of the sacrum go away after you are fused?

        Dr. Lenke's staff members have said they think that's what's causing my hip/sacrum pain while exercising, so I might need them out at two years if it's still bothering me.

        Thanks, Gayle. You must be coming up on the one-year anniversary of your revision, huh? Hope you're feeling well!

        Evelyn
        age 48
        80* thoracolumbar; 40* thoracic
        Reduced to ~16* thoracolumbar; ~0* thoracic
        Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
        Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
        Not "confused" anymore, but don't know how to change my username.

        Comment


        • #5
          Hi Evelyn,

          I had just a left iliac screw with my initial fusion, and I consistently had pain over it and in the left SI joint area. It was worse with exercise or weight-bearing activities like stairs or walking. Since there was no other hardware in that area, and all the spinal pathology was addressed during the first surgery, it seemed very likely that the iliac screw was the source of pain. My surgeon agreed but at one year post-op said to give it some time. Then when I broke my rods at 15 months I asked if he could remove it during the revision and he said sure.

          I am not sure why the risk of fracture goes away after a certain period of time. I did some reading in PubMed about iliac fixation and sacral fracture and come upon it, but I don't recall now. I did not need a new iliac screw with the revision.

          My one-year appt is coming up on Jan 29th. Overall I am doing very well, although it is hard now to not worry about breaking a rod again right at this point. I am looking forward to additional healing/improvement in soft tissues this coming year. I think there is definitely some improvement to be had still for me!
          Gayle, age 50
          Oct 2010 fusion T8-sacrum w/ pelvic fixation
          Feb 2012 lumbar revision for broken rods @ L2-3-4
          Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


          mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
          2010 VBS Dr Luhmann Shriners St Louis
          2017 curves stable/skeletely mature

          also mom of Torrey, 12 y/o son, 16* T, stable

          Comment


          • #6
            I am so happy to find this thread

            I am at 7 months post op and showing a lot of pain below my waist towards the sacrum. I recently (last month) bought a treadmill as per the Physical therapist that was new with Dr. Bridwell ( 6 months visit May 2013) and walking at higher speed that he recommended. After a month, I pain almost constantly here and there.

            I must have over done it and possibly (iliac screw pain) is the cause. Answers to problems makes me not wonder WHY? What am I doing wrong? Am I hurting the surgery work?

            I was painless for the first 6 months. Hope Bernie (Dr Bridwell's nurse) returns my call and tells me what I am possibly doing to cause the pains.
            Gardenia
            Baja California, Mexico & El Centro, Ca
            pre-surgery 75° and 89° - post ?
            Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
            T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

            Comment


            • #7
              Gardenia...did you discuss the treadmill with your surgeon before
              you started using it...???????????

              when i was going to go thru with surgery some years ago, surgeon
              told me he would NOT ALLOW me on a treadmill for a looong time...
              he said i should consider surgery during spring or summer,
              as walking naturally was what he would allow, indoors or out...
              this was in Manhattan, where weather wouldn't allow walking outdoors in winter months...

              jess

              Comment


              • #8
                Dear Gardenia,
                Please stop the treadmill---it is harder on you than walking normally. I can make myself hurt on it{fusion 2 years old}. Yet I can walk on sidewalks and not hurt. Please be careful!
                T10-pelvis fusion 12/08
                C5,6,7 fusion 9/10
                T2--T10 fusion 2/11
                C 4-5 fusion 11/14
                Right scapulectomy 6/15
                Right pectoralis major muscle transfer to scapula
                To replace the action of Serratus Anterior muscle 3/16
                Broken neck 9/28/2018
                Emergency surgery posterior fusion C4- T3
                Repeated 11/2018 because rods pulled apart added T2 fusion
                Removal of partial right thoracic hardware 1/2020
                Removal and replacement of C4-T10 hardware with C7 and T 1
                Osteotomy

                Comment


                • #9
                  Yes, stop the treadmill. I was about 6 or 7 months post op and thought I needed to kick it up a few notches and walked some steep hills. I had new pains and finally called Dr. Lenke's office after a week or so and was allowed to take Aleve which helped with the inflammation that I had caused by overdoing it. It really will pay off in the long term to be conservative for the first year. I walked miles and miles and did several exercises with weights for my arms while laying on my back on the bed. It is all you need for now. There is plenty of time to do more after a year.
                  Karen

                  Surgery-Jan. 5, 2011-Dr. Lenke
                  Fusion T-4-sacrum-2 cages/5 osteotomies
                  70 degree thoracolumbar corrected to 25
                  Rib Hump-GONE!
                  Age-60 at the time of surgery
                  Now 66
                  Avid Golfer & Tap Dancer
                  Retired Kdgn. Teacher

                  See photobucket link for:
                  Video of my 1st Day of Golf Post-Op-3/02/12-Bradenton, FL
                  Before and After Picture of back 1/7/11
                  tap dancing picture at 10 mos. post op 11/11/11-I'm the one on the right.
                  http://s1119.photobucket.com/albums/k630/pottoff2/

                  Comment


                  • #10
                    Umm...guess it's just me, but I have less pain from the treadmill (3.2 mph max) than sidewalk walking. Unevenness of sidewalk can irritate my iliac screw on left side. But I definitely agree you should not go so fast that it causes pain. And yes, take Aleve at six months!! :-)
                    age 48
                    80* thoracolumbar; 40* thoracic
                    Reduced to ~16* thoracolumbar; ~0* thoracic
                    Surgery 3/14/12 with Dr. Lenke in St. Louis, T4 to S1 with pelvic fixation
                    Broken rods 12/1/19; scheduled for revision fusion L1-L3-4 with Dr. Lenke 2/4/2020
                    Not "confused" anymore, but don't know how to change my username.

                    Comment


                    • #11
                      I was just thinking about my own Treadmill which is manual and at an incline. I'm sure a treadmill would be fine as long as it's flat.
                      Karen

                      Surgery-Jan. 5, 2011-Dr. Lenke
                      Fusion T-4-sacrum-2 cages/5 osteotomies
                      70 degree thoracolumbar corrected to 25
                      Rib Hump-GONE!
                      Age-60 at the time of surgery
                      Now 66
                      Avid Golfer & Tap Dancer
                      Retired Kdgn. Teacher

                      See photobucket link for:
                      Video of my 1st Day of Golf Post-Op-3/02/12-Bradenton, FL
                      Before and After Picture of back 1/7/11
                      tap dancing picture at 10 mos. post op 11/11/11-I'm the one on the right.
                      http://s1119.photobucket.com/albums/k630/pottoff2/

                      Comment


                      • #12
                        Thank you, everyone

                        Actually I had asked the nurse before m 6-mos visit with Dr Bridwell, she said OK. I was at an apartment complex and would do slow speeds at 1.2 and about less than .5 miles. It was good.

                        Then on my visit beginning of May, I spent almost 45 minutes with a PT (the last PT Janet had retired). This PT was young and likely very optimistic. He pointed out that I was walking with hip swinging more to the left so I should tighten my butts to avoid swing - something I constantly forget. Taught me some good exercises by leaning on the wall and scooting down (I was terrified) Then he ask me to get up on the exam table and told me lean back: WHAT?!!! I said I don't do that like that anymore, so he told me to just do it he would guide me with his big great arms. He is 6'5". What I did not hear but my daughter did was that for my one year check up I should be walking at 1.8

                        Reality is that I live in San Felipe, Baja California on an American gated community in the desert with great weather, an eyefull of the Sea of Cortez, and lots of mountain ranges behind in a U shape. But, the property totals 35,000 acres and individual lots are all spread out into communities. There are no streets but dirt roads although well maintained they are not smooth. Summer has started getting to be 110 degrees later.

                        During the visit in May to St Louis, I went to the bathroom at night, close the door, and did not turn on the light I fell back onto the toilet breaking the tank midway up from the seat. No damage but sore body for several days and fortunately the weekend before seeing Dr. B. so no damage showed on the xrays.

                        I've been doing the treadmill at 1 -1.2 miles/h very slow and walked until I got too tired. After the visit I convinced my husband that I could no longer walk the roads so we got the cheapest treadmill at Sears. His thought was as in my entire life, it would be money wasted as I would lose interest when there is pain and no gain, pre-surgery.

                        Back in Baja, I started at 1.2 increasing in stages (slowly but within 5 days I was up to 1.8). I started feeling the pains and back muscles no longer stiff would be felt. I have not taken any med for the pain as it is tolerable compared to pre-surgery.

                        But, Thanks my friends!!! I know it is hard to not want to recover faster but I just need to really slow down much more than my brain is up and ready.

                        Thanks again!!!
                        Gardenia
                        Baja California, Mexico & El Centro, Ca
                        pre-surgery 75° and 89° - post ?
                        Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
                        T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

                        Comment

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