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Updated: Mar 7, 2026
A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
Published on: January 6, 2023
S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note
Seung-Jae Hyun1, Ki-Jeong Kim2, Tae-Ahn Jahng2
1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-Gil, Bundang, Seongnam, 463-707, Gyeonggi, Republic of Korea. hyunsj@snu.ac.kr.
Purpose:
S2 alar-iliac (S2AI) screws are generally placed using an open approach, but have recently been shown to be implantable using a minimally invasive approach. Nevertheless, optimal screw positioning, even when supported by fluoroscopic guidance, is challenging in the complex anatomy of the sacral-pelvic area. This work presents our novel technique of S2AI sacropelvic fixation procedures performed with robotic guidance.
Methods:
This was a single-center, retrospective, mini case-series of adult spinal deformity patients in need of sacropelvic fixation as part of a longer thoraco-lumbar fusion. The surgeon drilled a pilot hole through a robotic guide and then inserted a K-wire. A Jamshidi needle was placed over the K-wire and used to advance the pilot hole anterolaterally.
Results:
Medical charts of four 60-70 year-old patients, who underwent robotic-guided insertion of S2AI screws in a minimally invasive approach were reviewed. Follow-up ranged between 10 and 13 months. Post-operative CTs and X-rays showed all eight trajectories were fully within the bone and accurately placed. Average surgery time per patient was 13 min with 5.3 s of fluoroscopy per screw. No intra- or post-operative complications occurred.
Conclusions:
Robotic-guidance with a Jamshidi needle technique was a safe and effective means for implanting S2AI screws in a minimally invasive approach.
