Novel Technique for Sacral Alar-Iliac (S2AI) Fixation

Objective: To provide reasoning and steps for the placement of sacral alar-iliac (S2AI) screws for pelvic arthrodesis to aid osseous lumbosacral fusion. Summary of Background Data: Studies support lower rates of screw breakage and need for revision surgery or hardware removal for S2AI screws compared with traditional iliac bolts, as well as low rates of pseudoarthrosis and arthritis associated with this hardware placement. Materials and Methods: A case video of S2AI placement demonstrates our operative technique and is accompanied by procedural description of surgical maneuvers. Results and Surgical Techniques: One patient underwent lumbosacral fusion surgery aided by S2AI-mediated pelvic fixation. Conclusions: The present technique utilizing S2AI screws provides for successful pelvic fixation to aid in lumbosacral fusion, with no need for subcutaneous tissue dissection and improved outcomes compared with traditional iliac bolts.