title: Modified iliac screw fixation: technique and clinical application.
abstract: BACKGROUND
  A conventional iliac bolt and the S2 alar iliac screw fixation technique (S2AI) are commonly used sacropelvic fixation techniques. However, conventional iliac bolt technique requires a lateral connector and commonly has prominent screw head problems. S2AI reportedly has a high instrument failure rate. We aim to introduce a modified iliac screw fixation technique and to investigate its clinical application in adult patients.
  
  
  METHODS
  The entrance site of the modified iliac screw fixation technique was 1 cm medial and 1 cm caudal from the posterosuperior iliac spine. From 2009 to 2015, ten adult patients underwent sacropelvic fixation with the modified iliac screw fixation technique in our spine clinic. A minimum 12-month clinical and radiographic follow-up was adopted. The mean follow-up period was 30.7 months (12-74 months). Mean number of fixation levels was 7.7 segments (5-10 segments).
  
  
  RESULTS
  Postoperatively, the C7 plumb line (SVA) was significantly decreased (P = 0.04). Upon the last X-ray, SVA did not differ between postoperative and the last X-ray (P = 0.1). There was no breakage during our follow-up period. There was no prominent screw head. There were no cases requiring implant removal.
  
  
  CONCLUSIONS
  The modified iliac screw fixation technique does not cause prominence in the sacral region, and does not require a lateral connector, both of which are necessary when using the classical iliac bolt technique. This technique also avoids the acute angle between the screw head and the shaft of the screw commonly seen in S2AI. The modified iliac screw fixation technique can be an effective alternative for sacropelvic fixation.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea.|Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, South Korea.
authors.forename: Seil
authors.initials: S
authors.lastname: Sohn
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea. chungc@snu.ac.kr.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. chungc@snu.ac.kr.|Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea. chungc@snu.ac.kr.
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung
authors.affiliation: Department of Orthopedics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Yongjung Jay
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea.
authors.forename: Chi Heon
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea.|Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Sung Bae
authors.initials: SB
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea.|Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.|Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, Seoul, Korea.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery*; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000379:methods; D013131:Spine / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome
keywords: S2 alar iliac fixation; Sacropelvic fixation; Spinal deformities; Spine