S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note.
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.
['Hyun|Seung-Jae|SJ|', 'Kim|Ki-Jeong|KJ|', 'Jahng|Tae-Ahn|TA|']
D000368:Aged D001863:Bone Screws D005260:Female D005500:Follow-Up Studies D006801:Humans D007085:Ilium D008297:Male D008875:Middle Aged D012189:Retrospective Studies D065287:Robotic Surgical Procedures D012447:Sacrum D013121:Spinal Curvatures D013123:Spinal Fusion D016896:Treatment Outcome
Adult spinal deformity Minimally invasive approach Robotic-guidance S2 alar-iliac screw