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  1. Home
  3. Impact Of Sex On S2-alar-iliac Pelvic Screw Position And Lumbosacral Rod Alignment In Adult Spine Deformity.
  1. Home
  3. Impact Of Sex On S2-alar-iliac Pelvic Screw Position And Lumbosacral Rod Alignment In Adult Spine Deformity.

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Impact of sex on S2-alar-iliac pelvic screw position and lumbosacral rod alignment in adult spine deformity.

Ramone M Brown1, Wasil Ahmed2, Matthew S Miyasaka2

  • 1Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 E 98th St, 4th Floor, New York, NY, 10029, USA. ramone.brown@icahn.mssm.edu.

Spine Deformity
|October 1, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

Sex-based anatomical differences impact S2AI screw placement and lumbosacral rod alignment. Preoperative planning should consider these pelvic morphology variations for optimal surgical outcomes.

Keywords:
Adult spinal deformityLumbosacral fixationRod alignmentS2-alar-iliacS2-alar-iliac screw placementS2AISex differences in pelvic anatomySpinopelvic parameters

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Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Surgical anatomy

Background:

  • S2 Alar-Iliac (S2AI) screw placement is crucial for lumbosacral fixation in complex spinal fusions.
  • Pelvic morphology varies between sexes, potentially influencing S2AI screw starting points and construct connectivity.
  • Understanding these anatomical differences is key for successful surgical planning.

Purpose of the Study:

  • To evaluate how sex and pelvic anatomy affect S2AI screw placement.
  • To analyze the impact on lumbosacral rod alignment in the coronal plane.
  • To identify potential challenges in connecting pelvic screws to fusion constructs.

Main Methods:

  • Radiographic analysis of consecutive S2AI screw placement cases.
  • Measurement of posterior superior iliac spine (PSIS) distance on CT scans.
  • Assessment of S2AI screw head distances and rod-to-rod angles.

    • Main Results:

    • Females have a significantly greater PSIS distance than males (p<0.01).
    • Males exhibit more convergent distal rod-to-rod angles compared to females (p<0.05).
    • PSIS distance strongly predicts rod-to-rod and screw distances; sex is a significant predictor for both.

    Conclusions:

    • S2AI screw placement is influenced by sex-based anatomical variations.
    • Preoperative assessment of pelvic morphology is essential for optimizing screw placement and construct alignment.
    • These findings aid in tailoring surgical strategies for individual patients.