Direct Iliac Screw vs Sacral- 2- Alar- Iliac Screws Technique for Sacropelvic Fixation: Technical Nuances and a Review of the Literature

Sacropelvic (SP) fixation is the immobilization of the sacroiliac joint to attain lumbosacral fusion and prevent distal spinal junctional failure. SP fixation is indicated in numerous spinal conditions (eg, scoliosis, multilevel spondylolisthesis, spinal/ sacral trauma, tumors, or infections). Many SP fixation techniques have been described in the literature. Currently, the most used surgical techniques for SP fixation are direct iliac screws and sacral- 2- alar- iliac screws. There is currently no consensus in the literature on which technique carries more favorable clinical outcomes. In this review, we aim to assess the available data on each technique and discuss their respective advantages and disadvantages. We will also present our experience with a modification of direct iliac screws using a subcrestal approach and outline the future prospects of SP fixation.