Surgical Technique and Accuracy of S2 Alar-Iliac Screw Insertion Using Intraoperative O-Arm Navigation: An Analysis of 120 Screws

Abstract

To evaluate the surgical technique and accuracy of S2 alar-iliac (SAI) screw placement using intraoperative O-arm-based 3-dimensional navigation (O-arm). This study involved 60 patients who underwent SAI screw placement using the O-arm system between September 2013 and September 2019. These surgeries were performed by 5 different surgeons. For O-arm-based SAI screw insertion, a reference frame was attached to the spinous process of the lower lumbar spine (usually L4) so as not to interfere with SAI screw insertion and to facilitate simultaneous L5-S posterior interbody fusion with navigation. The navigated probe, iliac tap, and screwdriver were used for SAI screw insertion. Screw placement accuracy and screw length were assessed using postoperative computed tomography. Perioperative complications were also evaluated. Mean age at surgery was 68.1 (range, 30-83) years. In total, 120 screws were inserted. Rate of accurate screw placement was 98.3% (118/120 screws). The 2 misplaced screws breached the anterior cortex of the sacrum. Mean screw length was 85.6 (range, 70-90) mm. There were no significant neurovascular or visceral complications perioperatively. SAI screw placement can be safely performed using the intraoperative O-arm system and our surgical technique.