Sacropelvic fixation: two case reports of a new percutaneous technique

Case report. To describe a new method of minimally invasive percutaneous sacropelvic fixation and to report on its use in two patients. The Galveston and iliac screw techniques are in widespread use for sacropelvic fixation, but neither technique is amenable to a percutaneous approach. The S2-alar-iliac technique is a recently described method that involves finding a pathway from the S2 sacrum into the ilium with fluoroscopy. We describe a new minimally invasive approach for this technique that allows percutaneous insertion of the screws and spinal construct. A 69-year-old female with follicular thyroid carcinoma metastatic to the sacrum and a 55-year-old male with a sacral fracture were both treated with the new technique. We have described this new technique and reviewed the patients' clinical history, radiographic imaging, and outcomes. Stable fixation was achieved in both cases. Blood loss was 70 and 45 mL, respectively. There were no intraoperative complications. To our knowledge, this report is the first description of a percutaneous minimally invasive approach to sacropelvic fixation in spinal fusion surgery. It is likely that this minimally invasive technique will result in less blood loss, lower infection rates, and a more rapid postoperative recovery than that associated with the more widely used open techniques.