Sacral Alar Iliac Fixation for Spine Deformity

INTRODUCTION: As the anatomy of the lumbosacral junction presents a unique challenge for the spine surgeon with regard to achieving a solid fusion, we describe the sacral alar iliac (SAI) technique, which can be used for the placement of pelvic anchors during posterior spinal arthrodesis. STEP 1 PATIENT POSITIONING: Position the patient prone on a radiolucent table. STEP 2 SURGICAL APPROACH: In approaching the starting point, perform limited dissection of the soft tissue between the S1 and S2 dorsal foramina, while taking care to minimize unnecessary dissection and blood loss. STEP 3 CHANNEL CREATION: ). STEP 4 SCREW PLACEMENT: In most children and adults, use screws with an outer diameter ≥9 mm, which are recommended to prevent screw breakage. STEP 5 ROD PLACEMENT: Ensure that the SAI screws are in line with the remainder of the spinal anchors to allow for ease of rod insertion. STEP 6 WOUND CLOSURE: Perform carefully layered wound closure per routine at the end of the case, with special attention to meticulous hemostasis. RESULTS: reported a mean pelvic obliquity correction of 70% and a mean major coronal Cobb angle correction of 67%.