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S2 alar-iliac screw

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 non-surgical 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 two cases in which spondylodiscitis in the lumbosacral spine was treated with a percutaneous stabilization using S2 alar-iliac (S2AI) screw technique...
October 15, 2016: World Neurosurgery
Marcus D Mazur, Mark A Mahan, Lubdha M Shah, Andrew T Dailey
BACKGROUND: S2-alar-iliac (S2AI) screws are 1 technique for lumbopelvic fixation to improve fusion rates across the lumbosacral junction that has gained wider acceptance. The S2AI screw crosses the cortical surfaces of the sacroiliac joint (SIJ), which may improve the biomechanical strength of the instrumentation. OBJECTIVE: To report preliminary radiographic outcomes of patients who underwent lumbopelvic fixation with S2AI screws with a minimum 12-month follow-up...
June 23, 2016: Neurosurgery
Wataru Ishida, Benjamin D Elder, Christina Holmes, C Rory Goodwin, Sheng-Fu L Lo, Thomas A Kosztowski, Ali Bydon, Ziya L Gokaslan, Jean-Paul Wolinsky, Daniel M Sciubba, Timothy F Witham
BACKGROUND: In sacropelvic fixation, the iliac screw technique offers biomechanically strong constructs, but its disadvantages include screw prominence, wound dehiscence, and postoperative pain secondary to the high profile nature. To overcome this drawback, S2-alar-iliac (S2AI) screws were developed as an alternative technique for sacropelvic fixation. This study aimed to compare the S2AI screw technique with the iliac screw technique in terms of postoperative symptomatic screw prominence...
September 2016: World Neurosurgery
Xiaobang Hu, Isador H Lieberman
PURPOSE: To review our experience with robotic guided S2-alar iliac (S2AI) screw placement. METHODS: We retrospectively reviewed patients who underwent S2AI fixation with robotic guidance. Screw placement and deviation from the preoperative plan were assessed by fusing preoperative CT (with the planned S2AI screws) to postoperative CT. The software's measurement tool was used to compare the planned vs. actual screw placements in axial and lateral views, at entry point to the S2 pedicle and at a 30 mm depth at the screws' mid-shaft, in a resolution of 0...
June 7, 2016: European Spine Journal
Benjamin D Elder, Wataru Ishida, Sheng-Fu L Lo, Christina Holmes, C Rory Goodwin, Thomas A Kosztowski, Ali Bydon, Ziya L Gokaslan, Jean-Paul Wolinsky, Daniel M Sciubba, Timothy F Witham
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To compare clinical and radiographic outcomes between the S2-alar-iliac (S2AI) and the iliac screw (IS) techniques in the adult population and clarify the clinical strength of S2AI screws. SUMMARY OF BACKGROUND DATA: S2AI screws have been described as an alternative method for lumbosacropelvic fixation in place of ISs. The S2AI technique has several advantages with lower prominence, increased ability to directly connect to proximal instrumentation, less extensive dissection of tissue, and enhanced biomechanical strength over the IS technique...
May 31, 2016: Spine
Zhen Liu, Yong Qiu, Huang Yan, Zong-shan Hu, Feng Zhu, Jun Qiao, Lei-lei Xu, Bin Wang, Yang Yu, Bang-ping Qian, Ze-zhang Zhu
The purpose of this study was to introduce a powerful technique for the treatment of kyphoscoliosis. There are currently multiple techniques for sacropelvic fixation, including trans-iliac bars and iliac and iliosacral screws. Several studies have documented the use of these instrumentation techniques; however, a ubiquitous problematic issue concerns the need for separate incisions for the use of offset connectors, which add to surgical time and morbidity. Any additional dissection of the skin, subcutaneous tissue or muscle in this area is believed to increase the incidence of complications of wound healing...
February 2016: Orthopaedic Surgery
Seil Sohn, Chun Kee Chung, Yongjung Jay Kim, Chi Heon Kim, Sung Bae Park, Hyejin Kim
BACKGROUND: A conventional iliac bolt and the S2 alar iliac screw fixation technique (S2AI) are commonly used sacropelvic fixation techniques. However, conventional iliac bolt technique requires a lateral connector and commonly has prominent screw head problems. S2AI reportedly has a high instrument failure rate. We aim to introduce a modified iliac screw fixation technique and to investigate its clinical application in adult patients. METHODS: The entrance site of the modified iliac screw fixation technique was 1 cm medial and 1 cm caudal from the posterosuperior iliac spine...
May 2016: Acta Neurochirurgica
Jong-Hwa Park, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng
A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest...
December 2015: Journal of Korean Neurosurgical Society
Marcus D Mazur, Vijay M Ravindra, Andrew T Dailey, Sara McEvoy, Meic H Schmidt
BACKGROUND: Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis. PURPOSE: To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction. STUDY DESIGN: Technical report...
2015: Frontiers in Surgery
Amit Jain, Hamid Hassanzadeh, Sophia A Strike, Emmanuel N Menga, Paul D Sponseller, Khaled M Kebaish
Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially...
September 16, 2015: Journal of Bone and Joint Surgery. American Volume
Haariss Ilyas, Howard Place, Aki Puryear
STUDY DESIGN: Retrospective chart review. OBJECTIVE: To compare short-term clinical and radiographic complications between iliac screw (IS) and S2 alar-iliac (S2AI) screw fixation techniques in the adult and pediatric populations. SUMMARY OF BACKGROUND DATA: Pelvic fixation with lumbosacral implants is in widespread practice with numerous indications. Several techniques for spinopelvic fixation have been described in the literature. Although the iliac screw technique is widely practiced, it presents several challenges, including the use of connectors, more lateral surgical dissection, and some complaints of pain over the posterior pelvis...
May 2015: Journal of Spinal Disorders & Techniques
Mostafa H El Dafrawy, Khaled M Kebaish
Pelvic insufficiency fractures are fairly common in elderly patients and can be a source of major functional impairment, particularly when they involve the ilium. Early rehabilitation with adequate pain relief has been the traditional method of treatment. The recently developed S2 alar iliac technique involves placing pelvic fixation into the ilium through a pathway from the sacral ala. The bony channel between the second dorsal sacral foramen and the anterior inferior iliac spine is used to provide rigid sacropelvic fixation for adult and pediatric spine deformities...
November 2014: Orthopedics
Umit Ozgur Guler, Engin Cetin, Onur Yaman, Ferran Pellise, Alba Villa Casademut, Montse Domingo Sabat, Ahmet Alanay, Francesco Sanchez Perez Grueso, Emre Acaroglu
BACKGROUND: Sacropelvic fixation (SPF) is an integral part of ASD surgery. Literature suggests that combination of S1 and iliac screws may be associated with lowest rate of complications. AIM: To analyze the rate and potential factors of mechanical failure associated with SPF in adult spinal deformity surgery. MATERIALS AND METHODS: Of 504 patients enrolled in a prospective multicentric database, 239 were treated conservatively and 265 were treated surgically...
May 2015: European Spine Journal
S Samuel Bederman, Peter Hahn, Vincent Colin, Douglas P 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. The S2AI method possesses advantages over the traditional Galveston technique...
July 26, 2013: Journal of Spinal Disorders & Techniques
Joseph R OʼBrien, Warren Yu, Brian E Kaufman, Brandon Bucklen, Kanaan Salloum, Saif Khalil, Manasa Gudipally
STUDY DESIGN: A biomechanical study conducted on cadaveric specimens. OBJECTIVE: (1) To compare the biomechanical strength of the S2 alar-iliac (S2AI) screw to traditional iliac fixation and (2) to examine the effect of length and trajectory on the S2AI screw. SUMMARY OF BACKGROUND DATA: A recent technique to attain spinal fixation distal to S1 pedicle screws is the S2AI screw using either an open or a percutaneous approach with an altered S2 alar screw trajectory to obtain purchase in the ilium...
September 15, 2013: Spine
H Koller, J Zenner, A Hempfing, L Ferraris, O Meier
OBJECTIVE: Increasing construct stability of lumbosacral instrumentations using S2-ala screws as an alternate to iliac screws. INDICATIONS: Revision surgery after failed lumbosacral fusion; long instrumentations to the sacrum; L5-S1 fusion without anterior support. CONTRAINDICATIONS: Lack of sacral bone stock. SURGICAL TECHNIQUE: Midline approach. The entry point for S2-ala screws is caudal to the posterior S1 foramen and close to the lateral sacral crest...
June 2013: Operative Orthopädie und Traumatologie
F Zhu, H D Bao, S Yuan, B Wang, J Qiao, Z Z Zhu, Z Liu, Y T Ding, Y Qiu
OBJECTIVE: To provide radiographic parameters for optimal placement of posterior second sacral alar iliac (S2AI) screw for instrumentation and fusion of scoliosis to the second sacral level in a Chinese population. METHODS: S2AI screw trajectories were mapped on three-dimensional computed tomography (3DCT) reconstructions of 60 normal adult pelvises. 1 mm inferior and 1 mm lateral to the S1 dorsal foramen were chosen as the entry point, and ideal S2AI screw trajectories were explored by rotating and cutting the 3D pelvis, ensuring that the trajectories were of maximum length and width...
July 2013: European Spine Journal
Francis H Shen, Jonathan R Mason, Adam L Shimer, Vincent M Arlet
INTRODUCTION: Obtaining a fusion, especially to the sacrum for adult deformity correction remains a challenge. Prior to modern fixation techniques, the reported fusion rates for adult scoliotic deformities were low. However sacropelvic fixation techniques for adult deformity continue to evolve. As a result, modern day pelvic fixation techniques have improved fusion rates at the base of long constructs. The purpose of this article is to discuss the history, indications, and modern fixation techniques for pelvic fixation in the surgical management of adult scoliosis patients...
March 2013: European Spine Journal
Mun Keong Kwan, Amit Jeffry, Chris Yin Wei Chan, Lim Beng Saw
INTRODUCTION: Studies of sacral pedicle anatomy have been reported in the European population. However, the feasibility for the use of S1, S2 and S2-ilium screws has not been fully investigated in the Asian population. PURPOSE: To assess feasibility, morphometric parameters and safety of S1, S2 and S2-ilium screw insertion in the Asian population. METHOD: 180 three dimensional computed tomography (CT) scans of pelvis (90 males and 90 females) with contrast were analysed using Mimics(®) version 13...
April 2012: Surgical and Radiologic Anatomy: SRA
Christopher T Martin, Timothy F Witham, Khaled M Kebaish
STUDY DESIGN: Case report. OBJECTIVE: To describe a new method of minimally invasive percutaneous sacropelvic fixation and to report on its use in two patients. SUMMARY OF BACKGROUND DATA: The Galveston and iliac screw techniques are in widespread use for sacropelvic fixation, but neither technique is amenable to a percutaneous approach. The S2-alar-iliac technique is a recently described method that involves finding a pathway from the S2 sacrum into the ilium with fluoroscopy...
April 20, 2011: Spine
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