A novel technique for placement of sacro-alar-iliac (S2AI) screws by K-wire insertion using intraoperative navigation

•Lumbosacropelvic stabilization is often required for spinal deformity correction.•S2-Alar-Iliac (S2AI) screws are a recent development in sacropelvic fixation.•We report accurate insertion of S2AI screws, using intraoperative CT and K-wires.•This allows for safe achievement of biomechanically robust, stabilizing construct in the spine. Sacral-iliac fixation techniques may be indicated in the management of various lumbosacral pathologies including spinal degeneration, infection, tumour resection, fracture, pseudarthrosis, correction of spinal deformities involving long fusion constructs to the sacrum and cases with poor sacral fixation. There are a number of options for lumbosacral fixation each with their own advantages and disadvantages. Though S2-alar-iliac (S2AI) have demonstrated promising advantages over alternatives, the complex anatomy of the spinopelvic region demands precise insertion of the screws to create a biomechanically robust construct safely. As such, we present a novel technique of using intra-operative CT navigation and K-wires to establish and secure a planned trajectory, thereby ensuring solid spinopelvic fixation with S2AI screws. This was performed as part of a long fusion construct for correction of kyphosis deformity in a male patient.