S2 Alar-Iliac Screw Insertion: Technical Note with Pictorial Guide

Yılmaz, Emre; Abdul-Jabbar, Amir; Tawfik, Tamir; Iwanaga, Joe; Schmidt, Cameron; Blecher, Ronen; Tubbs, R. Shane; Oskouian, Rod J.

doi:10.1016/j.wneu.2018.02.009

Cited by 34 publications

(22 citation statements)

References 18 publications

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“…T he insertion point for S 2 -alar screws is lateral, ranging from the midpoint between the S 1 /S 2 dorsal foramina and the S 1 dorsal foramen 8,9 . The insertion point using the S 2 -sacral ala line is more distal to that of S 2 -alar screws, because the S 2 -alar screw is directed toward the acetabulum, while the cut line, which follows the S 2 -sacral ala line, is designed to be almost parallel to the cortex at the sciatic notch 10 .…”

Section: Discussionmentioning

confidence: 99%

Preserving the Pelvic Ring at the Sciatic Notch During Resection of Malignant Bone Tumors at the Posterior Ilium

Sakamoto

Otsuki

Tanida

et al. 2020

Orthopaedic Surgery

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Resection of malignant bone tumors in the posterior ilium may result in pelvic ring disruption. Preserving the pelvic ring and keeping an adequate surgical margin is ideal, but is challenging, especially when the tumor extends to the sacroiliac joint. The current report proposes a line from the lateral point of the second sacral dorsal foramen to the anterior surface of sacral ala (S 2-sacral ala line), and cutting from the line to the ilium over the sciatic notch and to the sacral wing using thread saws. This preserves the cortex at the sciatic notch and the distal sacroiliac joint. Two posterior iliac tumors extending to the sacroiliac joint, a metastatic melanoma in a 75-year-old male, and an osteosarcoma in a 56-year-old male were resected. The resections were performed along the S 2-sacral ala line, and consequently lumbosacro-pelvic fusions were performed. Both patients were able to walk with one crutch. Indications for the method using the S 2-sacral ala line for iliac tumors may be limited. However, the method can increase pelvic ring preservation in cases with posterior iliac malignant bone tumors.

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Section: Discussionmentioning

confidence: 99%

Preserving the Pelvic Ring at the Sciatic Notch During Resection of Malignant Bone Tumors at the Posterior Ilium

Sakamoto

Otsuki

Tanida

et al. 2020

Orthopaedic Surgery

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“…Der Eintrittspunkt kann entweder anatomisch oder, bei perkutaner Implantation, mit Hilfe einer a. p. oder Becken-Inlet-Aufnahme identifiziert werden. Die Richtung der Schraubenimplantation ist 30-40°nach lateral und 20-30°nach kaudal [23]. Der Zielpunkt der Schraubentrajektorie befindet sich in der Spina iliaca anterior inferior, was bei der Implantation mit Hilfe eines Bildwandlers in der lateralen, a. p., und Obturator-Outlet-Aufnahme kontrolliert wird [23].…”

Section: Implantation Unter Röntgenkontrolleunclassified

“…Die Richtung der Schraubenimplantation ist 30-40°nach lateral und 20-30°nach kaudal [23]. Der Zielpunkt der Schraubentrajektorie befindet sich in der Spina iliaca anterior inferior, was bei der Implantation mit Hilfe eines Bildwandlers in der lateralen, a. p., und Obturator-Outlet-Aufnahme kontrolliert wird [23]. Die zwei Korticales des Iliosakralgelenkes müssen mit einem scharfen Instrument oder durch Schlagen mit einem Hammer überquert werden.…”

Section: Implantation Unter Röntgenkontrolleunclassified

Techniken der spinopelvinen Fixation bei Erwachsenen

et al. 2021

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ZusammenfassungMit der Entwicklung der Wirbelsäulenchirurgie werden Patienten in zunehmendem Maße mit Stabilisierungs- oder Fusionsverfahren versorgt, wobei die fusionierten Segmente häufig auch das Sakrum umfassen. Eine stabile Fusion des lumbosakralen Übergangs ist allerdings schwierig zu erhalten. Einer der Lösungen dieses Problems ist die Verankerung der Fixation im Becken, bzw. im Os ilium. Nach der ursprünglichen Methode der Iliumschraubenimplantation mit Eintrittspunkt an der Spina iliaca posterior superior wurden weitere Techniken und Trajektorien beschrieben, die verschiedene Vor- und Nachteile aufweisen. Trotz der laufenden technischen Weiterentwicklung ist die Implantationstechnik mittlerweile prinzipiell ausgereift, mit niedrigem Komplikationsprofil und wichtigen biomechanischen Vorteilen, sodass mit der Implantation bei längeren Spondylodesen nicht gezögert werden soll.

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“…In contrast, S2AI screws are placed lateral to the interval between the S1 and S2 neural foramina, again aimed at the AIIS. 6 Since these iliac screws are in line with S1 and lumbar pedicle screws, this technique obviates the need for lateral connectors. 3 Furthermore, this technique allows for longer screw placement, theoretically conferring greater construct strength while minimizing hardware prominence and soft tissue disruption.…”

Section: Introductionmentioning

confidence: 99%

“…3 However, S2AI screws are technically arduous and frequently require extensive radiation exposure to confirm placement. 6,7 Additionally, the S2AI screws traverse the unfused sacroiliac (SI) joint, which may lead to pain and excess stress on the spinopelvic fixation elements, ultimately leading to screw breakage, 8 which may necessitate revision surgery for hardware replacement or removal.…”

Section: Introductionmentioning

confidence: 99%

Distal Ventral Iliac Pathway for Spinopelvic Fixation: Technique Description and Case Series

et al. 2021

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Background: Pelvic fixation improves the stability of spinal instrumentation and can be used in high-grade degenerative disease, trauma, deformity, and destabilizing invasive pathologies, such as infection and tumor. Classic techniques for spinopelvic fixation include traditional iliac screws and S2-Alar-Iliac screws. We present a case series describing the distal ventral iliac pathway (DVIP) for spinopelvic fixation and discuss surgical indications and merits of this technique. We describe the use of the DVIP for spinopelvic fixation in the setting of degenerative and traumatic pathologies, compare this technique with existing approaches, and summarize literature to support this approach.Methods: One hundred twenty-eight cases of DVIP screws were identified at 1 academic medical center, and 3 cases were chosen as representative examples for technique demonstration.Results: Patient ages ranged from 19 to 81 (mean 62) years. Intraoperative and postoperative complications include 12 incidental durotomies, 3 suprafascial infections, and 2 compressive hematomas. There were 22 instances of hardware failure and 8 instances of pseudoarthrosis. Overall, 26 patients underwent revision surgery. Mean estimated blood loss, operative time, and time under fluoroscopy were 1959 mL, 386 minutes, and 3.19 minutes, respectively.Conclusions: The DVIP is both safe and effective as a treatment for patients with degenerative and traumatic lumbosacral pathology. Spinopelvic fixation provides improved soft tissue coverage and fewer hardware complications at minimum of 1 year follow up. This case series demonstrates a novel surgical technique for spinopelvic fixation in the setting of numerous spinal pathologies.Level of Evidence: 4. Clinical Relevance: This surgical technique is less technically challenging than current approaches, minimizes radiation exposure, and obviates the need for horizontal connector rods. In addition, in highly destabilizing pathologies, this technique also allows for multiple screw placement within the ilium, while maintaining the ability to connect to a single rod construct. This technique is safe, technically approachable, and broadly applicable to an array of spinopelvic pathologies.

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S2 Alar-Iliac Screw Insertion: Technical Note with Pictorial Guide

Cited by 34 publications

References 18 publications

Preserving the Pelvic Ring at the Sciatic Notch During Resection of Malignant Bone Tumors at the Posterior Ilium

Preserving the Pelvic Ring at the Sciatic Notch During Resection of Malignant Bone Tumors at the Posterior Ilium

Techniken der spinopelvinen Fixation bei Erwachsenen

Distal Ventral Iliac Pathway for Spinopelvic Fixation: Technique Description and Case Series

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