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September 5, 2025Open Access

Comparative efficacy of S2-alar-iliac versus iliac screw techniques in treating adult spinal deformity: a meta-analysis of postoperative outcomes and complications

ASAmit SarafTeerthanker Mahaveer University SJSanjeev Kumar JainChaudhary Charan Singh University DSD. SharmaTeerthanker Mahaveer University

Key Points

S2-alar-iliac fixation significantly reduces estimated blood loss by 140.7 mL, improving postoperative recovery.
Significant reductions in complications like wound infection and screw prominence were noted in the S2-alar-iliac cohort.
Both S2-alar-iliac and iliac screw techniques showed comparable outcomes in terms of operation time and implant failure rates.
This meta-analysis indicates a trend towards better overall outcomes with S2-alar-iliac fixation, highlighting its effectiveness.

Abstract

Pelvic fixation has become increasingly important in treating spinal deformities that affect the lumbosacral junction. The sacral 2 alariliac screw (S2AI) and iliac screw (IS) fixations are two commonly used techniques. This meta-analysis aimed to systematically compare the clinical outcomes of S2AI and IS techniques in adult spinal deformity. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases, using combinations of keywords such as "S2-alar-iliac," "iliac screw," "spinopelvic fixation," "lumbosacral surgery," and "clinical outcomes." The search was restricted to articles published up to October 2024. Sixteen studies were included in the analysis. The S2AI cohort showed significant advantages in terms of reduced estimated blood loss (mean difference MD, -140.70; p=0.006), shorter hospital stays (MD, -1.50; p=0.01), and improved ambulatory status (MD, 0.22; p=0.004). Additionally, the S2AI group had significantly lower incidence of complications, including screw prominence (odds ratios OR, 0.08; p=0.001), wound infection (OR, 0.24; p=0.0001), wound dehiscence (OR, 0.14; p=0.0001), and reduced need for revision surgeries (OR, 0.32; p=0.0001). There were no significant differences between the S2AI and IS cohorts regarding the sagittal vertical axis (MD, 1.49; p=0.23), Visual Analog Scale pain scores (MD, 0.01; p=0.94), operation time (MD, -31.23; p=0.28), postoperative Oswestry Disability Index (ODI) (MD, 0.14; p=0.84), implant failure (OR, 0.74; p=0.23), pelvic tilt (MD, -0.44; p=0.65), sacral slope (MD, -0.82; p=0.46), lumbar lordosis (MD, -0.19; p=0.89), or pelvic incidence (MD, -0.38; p=0.78). This meta-analysis suggests that while both S2AI and IS fixations have similar outcomes in terms of implant failure, operation time, and postoperative ODI, S2AI may have better outcomes in terms of revision, screw prominence, and wound complications.

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