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Moreover, the usage of an additional offset-connector would complicate the procedure and prolong the operation duration.

However, implant prominence at posterior superior iliac spine (PSIS) was the most unacceptable complication, which induced higher wound infection rate and increasing revision procedure due to surgical site infection. Achievement of high fusion rate has been reported with reliable security by iliac screw placement in spine disorders including HGS.

Since the advent of the Galveston technique to treat spinal scoliosis by Allen and Ferguson, the concept and technique of spinal-pelvic fixation have been widely accepted and applied in diversity clinical practices. Recently, partial reduction of HGS with the goal of slip angle reduction and lumbosacral kyphosis correction, combined with anterior column structural support, lead to greater stability at the lumbosacral junction, improved sagittal alignment and higher fusion rate. The surgical treatment of HGS remains challenging and is associated with significant controversies in terms of the optimal surgical technique. Moreover, HGS invariably induce secondary changes in the regional pelvic anatomy and can thus produce global sagittal deformity, which might be another indication for surgery. Surgery is indicated in HGS patients with back pain and/or radicular symptoms if conservative treatment fails. High-grade spondylolisthesis (HGS) is defined as greater than 50% slippage of a spinal vertebral body relative to an adjacent vertebral body as per Meyerding classification, and most often affects the alignment of the L5 and S1 vertebral bodies.

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