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S2 alar-iliac screw

Taolin Fang, Glenn S Russo, Gregory D Schroeder, Christopher K Kepler
Achieving an osseous fusion across the lumbosacral spine is still challenging in spine surgery. For the long multisegmental fusion surgery, it is crucial to build a robust and substantial foundation, which sometimes necessitates the distal spinal fixation to the pelvis. The pelvic fixation technique involves advancing the screw through the alar, thereby providing more purchase across the sacroiliac joint and into the ilium. The S2 alar iliac screws can obtain immediate stability and proper biomechanical strength of constructs...
March 16, 2018: Clinical Spine Surgery
Jamal N Shillingford, Joseph L Laratta, Lee A Tan, Nana O Sarpong, James D Lin, Charla R Fischer, Ronald A Lehman, Yongjung J Kim, Lawrence G Lenke
BACKGROUND: Spinopelvic fixation is an integral part of achieving solid fusion across the lumbosacral junction, especially in deformity procedures requiring substantial correction or long-segment constructs. Traditional S2-alar-iliac (S2AI) screw-placement techniques utilize fluoroscopy, increasing operative time and radiation exposure to the patient and surgeon. We describe a novel free-hand technique for S2AI screw placement in patients with adult spinal deformity. METHODS: We reviewed the records of 45 consecutive patients who underwent spinopelvic fixation performed with use of S2AI screws by the senior surgeon and various fellows or residents over a 12-month period (2015 to 2016)...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
Joseph L Laratta, Jamal N Shillingford, Joseph M Lombardi, Rami G Alrabaa, Barlas Benkli, Charla Fischer, Lawrence G Lenke, Ronald A Lehman
STUDY DESIGN: Case series. OBJECTIVES: To determine the safety and feasibility of S2 alar-iliac (S2AI) screw placement under robotic guidance. SUMMARY OF BACKGROUND DATA: Similar to standard iliac fixation, S2AI screws aid in achieving fixation across the sacropelvic junction and decreasing S1 screw strain. Fortunately, the S2AI technique minimizes prominent instrumentation and the need for offset connectors to the fusion construct. Herein, we present an analysis of the largest series of robotic-guided S2AI screws in the literature without any significant author conflicts of interest with the robotics industry...
March 2018: Spine Deformity
Joseph L Laratta, James D Lin, Jamal N Shillingford, Nathan E Hardy, Hemant Reddy, Ronald A Lehman
Achieving lumbosacral fusion through spinopelvic fixation is an important and challenging aspect of spinal deformity surgery. Numerous instrumentation techniques are available, with iliac screws and S2-alar-iliac (SRAI) screws being most commonly used today. However, the increasing popularity of minimally invasive sacroiliac (SI) fusion as a common procedure performed for SI joint pain presents a distinct challenge in complex adult deformity cases requiring iliac screw fixation. We report a case of a 71-year-old female with a longstanding history of spinal deformity status-post T11-L5 fusion and a subsequent right-sided SI joint fusion who presented with sagittal imbalance...
December 2017: Journal of Spine Surgery (Hong Kong)
Carlos Segundo Montero, David Alberto Meneses, Fernando Alvarado, Wilmer Godoy, Diana Isabel Rosero, Jose Manuel Ruiz
Background: Multiple techniques are utilized for distal fixation in patients with neuromuscular scoliosis. Although there is evidence of benefit with S2 alar iliac (S2AI) fixation, this remains controversial. The objective of this study is to evaluate the radiological outcomes and complications associated with this surgical technique in a pediatric population. Methods: An observational retrospective case series study was performed. All pediatric patients between January 2011 and February 2014 diagnosed with neuromuscular scoliosis associated with pelvic obliquity, which required surgery with fixation unto S2AI, were included...
December 2017: Journal of Spine Surgery (Hong Kong)
Ho Yong Choi, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
Objective: Among the various sacropelvic fixation methods, S2 alar-iliac (S2AI) screw fixation has several advantages compared to conventional iliac wing screw. However, the placement of S2AI screw still remains a challenge. The purpose of this study was to describe a novel technique of free hand S2AI screw insertion using a K-wire and cannulated screw, and to evaluate the accuracy of the technique. Methods: S2AI screw was inserted by free hand technique in sixteen consecutive patients without any fluoroscopic guidance...
January 2018: Journal of Korean Neurosurgical Society
Evan J Smith, Justin Kyhos, Robert Dolitsky, Warren Yu, Joseph O'Brien
STUDY DESIGN: Retrospective review of patients having undergone S2 alar-iliac (S2AI) fixation for long fusions with a minimum two-year follow-up. OBJECTIVES: To report on fusion rates, complications, technique-specific complications of patients having undergone S2AI fixation. SUMMARY OF BACKGROUND DATA: Sacropelvic fixation continues to be a challenge when performing long fusions to the pelvis. S2AI screws have been found to provide solid biomechanical fixation and have been found to have good clinical results in short-term follow-up for pediatric and adult patients...
January 2018: Spine Deformity
Tatsuro Sasaji, Hideki Imaizumi, Taishi Murakami
Low transverse sacral fractures are rare, with only two published reports regarding their surgery. The complication associated with surgery for sacral fractures is the prominence of implants. In addition, screw fixation below S3 is impractical. We performed posterior sacral fixation using S2 alar iliac (S2AI) screws and sacral sublaminar wires for low transverse sacral fractures. Case 1 was 65-year-old male with an S2-3 transverse sacral fracture. We performed laminectomy (S2-3) and passed ultrahigh molecular weight polyethylene (UHMWPE) cables from laminectomy area to the third posterior sacral foramina...
2017: Case Reports in Orthopedics
Wataru Ishida, Benjamin D Elder, Christina Holmes, Sheng-Fu L Lo, C Rory Goodwin, Thomas A Kosztowski, Ali Bydon, Ziya L Gokaslan, Jean-Paul Wolinsky, Daniel M Sciubba, Timothy F Witham
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The S2-alar-iliac (S2AI) technique has been described as an alternative method for pelvic fixation in place of iliac screws (ISs) in spinal deformity surgery. The objective of this study was to analyze the impact of S2AI screws on radiographical outcomes, including spinopelvic parameters. METHODS: A retrospective review of 17 patients receiving ISs and 46 patients receiving S2AI screws for correction of adult spinal deformity between 2010 and 2015 with minimum 1-year follow-up was conducted...
October 2017: Global Spine Journal
Kevin Phan, Julian Li, Gloria Giang, Ian Teng, Steven Phan, Nicholas Chang, Ralph Mobbs
Sacral-iliac fixation techniques may be indicated in the management of various lumbosacral pathologies including spinal degeneration, infection, tumour resection, fracture, pseudarthrosis, correction of spinal deformities involving long fusion constructs to the sacrum and cases with poor sacral fixation. There are a number of options for lumbosacral fixation each with their own advantages and disadvantages. Though S2-alar-iliac (S2AI) have demonstrated promising advantages over alternatives, the complex anatomy of the spinopelvic region demands precise insertion of the screws to create a biomechanically robust construct safely...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mark C Lee, Casey Jarvis, Matthew J Solomito, Jeffrey D Thomson
BACKGROUND CONTEXT: Many pelvic fixation options exist for posterior spinal fusion of pediatric neuromuscular scoliosis, including standard iliac screws (SISs) or a more recently introduced S2-Alar (S2A) technique. However, little data exist comparing the clinical and radiographic outcomes of these techniques. PURPOSE: This study aimed to dentify differences in clinical and radiographic outcomes for pediatric neuromuscular scoliosis patients treated with SIS or S2A pelvic fixation...
September 21, 2017: Spine Journal: Official Journal of the North American Spine Society
Faheem A Sandhu, Jason E McGowan, Daniel R Felbaum, Hasan R Syed, Kyle B Mueller
STUDY DESIGN: A retrospective analysis of two consecutive patients who underwent a novel surgical technique. OBJECTIVE: A report of a novel surgical technique utilizing an electronic conductivity device guidance to aide placement of S2-Alar-Iliac (S2-AI) instrumentation. Electronic conductivity guidance for instrumentation of the thoracolumbar spine is an accepted means of improving intraoperative accuracy. Although commercially available for percutaneous techniques, there is a paucity of literature regarding its use...
November 2017: European Spine Journal
Katsutaka Yamada, Takayuki Higashi, Kanichiro Kaneko, Manabu Ide, Tatsuhiro Sekiya, Tomoyuki Saito
OBJECTIVE: The aim of this study was to analyse the optimal trajectories for sacral alar iliac screws (SAISs) in a Japanese patient population and the clinical assessment of insertion accuracies. METHODS: The ideal trajectories of SAISs, starting from 2 mm medial to the apex of the lateral sacral crest on the midline between S1 and S2 dorsal foramina, were measured in 80 consecutive spinal disease patients (40 males and 40 females; average age: 67.4 ± 8.1 years) using three-dimensional computed tomographic image software...
June 2, 2017: Acta Orthopaedica et Traumatologica Turcica
Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng
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...
August 2017: European Spine Journal
Daniel G Hoernschemeyer, Troy D Pashuck, Ferris M Pfeiffer
BACKGROUND CONTEXT: Arthrodesis of the lumbosacral junction continues to be a challenge in pediatric and adult spinal deformity surgery. PURPOSE: To evaluate the biomechanical rigidity of two types of lumbosacral fixation. Our hypothesis was that the use of S2 alar-iliac (S2AI) fixation will result in statistically similar biomechanical fixation as compared with use of an iliac screw with a 95% confidence interval. STUDY SETTING: Controlled biomechanical laboratory METHODS: Ten human cadaveric lumbosacral specimens were separated into two test groups: (1) S2AI (n=5) and (2) iliac screw (n=5)...
February 6, 2017: Spine Journal: Official Journal of the North American Spine Society
S Samuel Bederman, Peter Hahn, Vincent Colin, P Douglas Kiester, Nitin N Bhatia
STUDY DESIGN: A retrospective cohort study of patients who underwent S2-alar-iliac (S2AI) screw insertion using robotic guidance in long constructs for spinal deformity correction extending to the sacrum performed at a single institution. OBJECTIVE: To assess and evaluate the feasibility and accuracy of robotic guidance for S2AI screw insertion. SUMMARY OF BACKGROUND DATA: Pelvic fixation has become a common adjunct to long fusions extending to the sacrum...
February 2017: Clinical Spine Surgery
Chester E Sutterlin, Antony Field, Lisa A Ferrara, Andrew L Freeman, Kevin Phan
BACKGROUND: S1 screw failure and L5/S1 non-union are issues with long fusions to S1. Improved construct stiffness and S1 screw offloading can help avoid this. S2AI screws have shown to provide similar stiffness to iliac screws when added to L3-S1 constructs. We sought to examine and compare the biomechanical effects on an L2-S1 pedicle screw construct of adding S2AI screws, AxiaLIF, L5-S1 interbody support via transforaminal lumbar interbody fusion (TLIF), and to examine the effect of the addition of cross connectors to each of these constructs...
December 2016: Journal of Spine Surgery (Hong Kong)
Camden B Burns, Karan Dua, Nicholas A Trasolini, David E Komatsu, James M Barsi
STUDY DESIGN: Biomechanical cadaveric study. OBJECTIVE: To compare the biomechanical properties of the iliac and S2-Alar-Iliac (S2AI) screw in a similar spinopelvic fixation construct. SUMMARY OF BACKGROUND DATA: Spinopelvic fixation is used in the correction of pelvic obliquity, high-grade spondylolisthesis, and long spinal fusions. With the development of pedicle screw fixation, the iliac screw has been used as an anchor point to the pelvis...
January 2016: Spine Deformity
Haruki Funao, Khaled M Kebaish, Norihiro Isogai, Takahiro Koyanagi, Morio Matsumoto, Ken Ishii
BACKGROUND: Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique...
January 2017: World Neurosurgery
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