• H Koller, J Zenner, A Hempfing, L Ferraris, and O Meier.
• Werner-Wicker-Clinik, German Scoliosis Center, Im Kreuzfeld 4, 34537 Bad Wildungen, Germany. Heiko.koller@t-online.de
• Oper Orthop Traumatol. 2013 Jun 1;25(3):294-314.

ObjectiveIncreasing construct stability of lumbosacral instrumentations using S2-ala screws as an alternate to iliac screws.IndicationsRevision surgery after failed lumbosacral fusion; long instrumentations to the sacrum; L5-S1 fusion without anterior support.ContraindicationsLack of sacral bone stock.Surgical TechniqueMidline approach. The entry point for S2-ala screws is caudal to the posterior S1 foramen and close to the lateral sacral crest. Screw tract preparation for S2-ala screws necessitates 30-45° angulation in the axial plane. Biplanar fluoroscopy with inlet and outlet views ensure screw accuracy. With S2-ala screws, bicortical fixation is the goal.Postoperative ManagementPatients are mobilized under the surveillance of physiotherapists on day 1 and released from the hospital after 10 days. Clinical and radiographic controls are performed at 6, 12 and 24 months.ResultsRetrospective review of 80 patients undergoing S2-ala screw fixation. Main diagnosis was degenerative lumbar instability, adult scoliosis, high-grade listhesis, and nonidiopathic scoliosis. In 66% of patients, the instrumentation using S2-ala screws was part of a major lumbosacral revision surgery. Follow-up averaged 26 months. There were no deaths or major neurovascular complications. First time fusion rate at L5-S1 was greater than 90%. Eight patients (10%) experienced a complication which could be related to the S2-ala screws. Out of 160 S2-ala screws, 16 screws were judged to cause focal irritation and were removed, indicating a survival rate of 90% for the S2-ala screw.

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