S2 alar-iliac screws versus iliac screws for pelvic fixation

Achieving a sacropelvic fusion continues to be a challenge due to complex anatomy biomechanics and morbidity associated with invasive procedures. Initially, the Galveston technique was utilized until the introduction of iliac screws (IS) in the early 2000s, which showed improved fusion rates and decreased complications (1-3). However, drawbacks to the IS technique include extensive dissection of paraspinal muscles, screw prominence given its high profile, and the requirement of offset connector use (4,5).