To avoid complications leading to failure of S1 pedicle screws, multiple solutions for load-sharing have been used, including bilateral iliac screw fixation and interbody fusion. Interbody graft placement increases compression stiffness and helps to restore sagittal alignment. Lack of rigid sacral fixation, such as with bilateral bicortical S1 screws, anterior column support, or bilateral iliac screws, has been associated with a significantly increased risk of pseudarthrosis and, thus, poor patient satisfaction