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

Emre Yilmaz1, Amir Abdul-Jabbar2, Tamir Tawfik2

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This study details a safe technique for S2 alar-iliac (S2AI) screw placement, crucial for sacrum-to-ilium fixation. Anatomical illustrations and fluoroscopic guidance ensure correct screw insertion, improving surgical outcomes.

Keywords:
Lumbopelvic fixationS2AISacrumSpinopelvic fixationTechnique

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Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Anatomical studies

Background:

  • The S2 alar-iliac (S2AI) screw technique fixes the sacrum to the ilium.
  • Existing literature lacks detailed anatomical review and precise insertion points for S2AI screws.
  • Variations in reported insertion angles necessitate clearer procedural guidance.

Purpose of the Study:

  • To provide a step-by-step anatomical illustration of the S2AI screw technique.
  • To detail methods for confirming safe S2AI screw placement using fluoroscopic imaging.

Main Methods:

  • Procedure performed on cadaveric specimens (left and right sides).
  • Standard posterior midline exposure with fellowship-trained and attending spine surgeons.
  • Utilized anteroposterior, inlet, lateral, obturator-outlet, and teardrop fluoroscopic views.

Main Results:

  • Identified insertion point: 10 mm lateral between S1 and S2 foramina, near the sacroiliac joint.
  • Recommended angulation: 30°-40° lateral (transverse plane), 20°-30° caudal (sagittal plane).
  • Fluoroscopic views confirmed screw placement, avoiding misplacement by identifying key anatomical landmarks.

Conclusions:

  • Fluoroscopic guidance is essential for accurate S2AI screw placement.
  • The described technique facilitates safe and correct S2AI screw insertion.