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S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note

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Abstract

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-Gil, Bundang, Seongnam, 463-707, Gyeonggi, Republic of Korea

    Seung-Jae Hyun, Ki-Jeong Kim & Tae-Ahn Jahng

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  1. Seung-Jae Hyun
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  2. Ki-Jeong Kim
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Correspondence to Seung-Jae Hyun.

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Hyun, SJ., Kim, KJ. & Jahng, TA. S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note. Eur Spine J 26, 2198–2203 (2017). https://doi.org/10.1007/s00586-017-5012-z

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