{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T22:54:37Z","timestamp":1769986477626,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,18]]},"abstract":"\n BACKGROUND<\/jats:title>\n Sacropelvic fixation is used in the management of deformity, neoplasms, and fractures. S2-alar-iliac (S2AI) screws have evolved as a technique for sacropelvic fixation to address disadvantages associated with traditional iliac screws. In select patients, S2AI screw placement is not feasible due to patient anatomy, trauma, or osteolytic lesions.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 15-year-old girl presented with a 3-month history of right S1\u20132 radicular pain and right dorsiflexion and plantar flexion weakness. Imaging revealed a right sacral alar aneurysmal bone cyst. The patient underwent right S1\u20133 hemilaminectomies and partial resection of the S2 and S3 vertebral bodies. Following adequate bony decompression, tumor debulking was performed. Bilateral L4\u2013S1 pedicle screws and left S2AI screws were then placed using neuronavigation guidance. Due to right S1\u20132 sacral resection, S2AI screw placement was unfeasible. Right-S3 alar-iliac (S3AI) screw placement was performed, and good sacropelvic fixation was demonstrated. Herein, the authors describe the first clinical application of S3AI screw placement in a pediatric patient. After surgery, the patient experienced an improvement in symptoms before later tumor recurrence, which required adjuvant therapy. Long term follow-up revealed solid fusion with stable spinal alignment.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n In select patients in whom S2AI screw placement is not an option, S3AI screw placement is a feasible, safe, alternative for sacropelvic fixation.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25267<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25267","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:48:19Z","timestamp":1756770499000},"source":"Crossref","is-referenced-by-count":0,"title":["S3 sacral-alar iliac screws application in partial sacral resection for an aneurysmal bone cyst: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Hudin N.","family":"Jackson","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hamre","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David F.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"suppl 2","key":"bib1","series-title":"J Bone Joint Surg Am","first-page":"89","article-title":"Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques","volume":"87","author":"Moshirfar","year":"2005","unstructured":"Moshirfar ARand FFSponseller PDPelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am. 2005;87(suppl 2):89-106."},{"key":"bib2","series-title":"World Neurosurg","first-page":"e296","article-title":"S2 alar-iliac screw insertion: technical note with pictorial guide","volume":"113","author":"Yilmaz","year":"2018","unstructured":"Yilmaz EAbdul-Jabbar ATawfik TS2 alar-iliac screw insertion: technical note with pictorial guide. World Neurosurg. 2018;113:e296-e301."},{"key":"bib3","series-title":"World Neurosurg","first-page":"408","article-title":"Comparison of complications and revisions after sacral 2 alar iliac screw and iliac screw fixation for sacropelvic fixation in pediatric and adult populations: systematic review and meta-analysis","volume":"132","author":"Keorochana","year":"2019","unstructured":"Keorochana GArirachakaran ASetrkraising KKongtharvonskul J.Comparison of complications and revisions after sacral 2 alar iliac screw and iliac screw fixation for sacropelvic fixation in pediatric and adult populations: systematic review and meta-analysis. World Neurosurg. 2019;132:408-420.e1."},{"issue":"3","key":"bib4","series-title":"Neurosurgery","first-page":"183","article-title":"Long-segment spinal fixation using pelvic screws","volume":"63","author":"Tumial\u00e1n","year":"2008","unstructured":"Tumial\u00e1n LMMummaneni PV.Long-segment spinal fixation using pelvic screws. Neurosurgery. 2008;63(3)(suppl):183-190."},{"issue":"12","key":"bib5","series-title":"Spine","first-page":"E439","article-title":"An anatomic study of the S2 iliac technique for lumbopelvic screw placement","volume":"34","author":"O'Brien","year":"2009","unstructured":"O'Brien JRYu WDBhatnagar RSponseller PKebaish KM.An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine. 2009;34(12):E439-E442."},{"issue":"1","key":"bib6","series-title":"J Orthop Surg Res","first-page":"136","article-title":"Three-dimensional digital anatomical measurement of modified sacroiliac screws","volume":"17","author":"Wang","year":"2022","unstructured":"Wang TZhao BYan JWang JChen CMu W.Three-dimensional digital anatomical measurement of modified sacroiliac screws. J Orthop Surg Res. 2022;17(1):136."},{"issue":"2","key":"bib7","series-title":"J Neurosurg Spine","first-page":"253","article-title":"Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis","volume":"30","author":"De la Garza","year":"2018","unstructured":"De la Garza RRNakhla JSciubba DMIliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis. J Neurosurg Spine. 2018;30(2):253-258."},{"issue":"3","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"E142","article-title":"Use of S2-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation","volume":"42","author":"Elder","year":"2017","unstructured":"Elder BDIshida WLo SLUse of S2-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine (Phila Pa 1976). 2017;42(3):E142-E149."},{"key":"bib9","series-title":"PeerJ","first-page":"e1587","article-title":"The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study","volume":"4","author":"Wu","year":"2016","unstructured":"Wu AMChi YLNi WFHuang YX.The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study. PeerJ. 2016;4:e1587."},{"key":"bib10","series-title":"World Neurosurg","first-page":"23","article-title":"S3 sacral-alar iliac screw: a salvage technique for pelvic fixation in complex deformity surgery","volume":"139","author":"Mattei","year":"2020","unstructured":"Mattei TA.S3 sacral-alar iliac screw: a salvage technique for pelvic fixation in complex deformity surgery. World Neurosurg. 2020;139:23-30."},{"issue":"2","key":"bib11","series-title":"Arch Orthop Trauma Surg","first-page":"177","article-title":"Morphometric measurement and applicable feature analysis of sacral alar\u2013iliac screw fixation using forward engineering","volume":"140","author":"Liu","year":"2020","unstructured":"Liu FYang YWen CMorphometric measurement and applicable feature analysis of sacral alar\u2013iliac screw fixation using forward engineering. Arch Orthop Trauma Surg. 2020;140(2):177-186."},{"issue":"3","key":"bib12","series-title":"J Neurosurg Spine","first-page":"367","article-title":"A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model","volume":"30","author":"Cunningham","year":"2019","unstructured":"Cunningham BWSponseller PDMurgatroyd AAKikkawa JTortolani PJ.A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model. J Neurosurg Spine. 2019;30(3):367-375."},{"issue":"4","key":"bib13","series-title":"Acta Orthop Traumatol Turc","first-page":"313","article-title":"Optimal trajectory and insertion accuracy of sacral alar iliac screws","volume":"51","author":"Yamada","year":"2017","unstructured":"Yamada KHigashi TKaneko KIde MSekiya TSaito T.Optimal trajectory and insertion accuracy of sacral alar iliac screws. Acta Orthop Traumatol Turc. 2017;51(4):313-318."},{"issue":"3","key":"bib14","series-title":"J Neurosurg Spine","first-page":"321","article-title":"Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: technical note","volume":"19","author":"Mattei","year":"2013","unstructured":"Mattei TAFassett DR.Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: technical note. J Neurosurg Spine. 2013;19(3):321-330."},{"issue":"suppl 2","key":"bib1","series-title":"J Bone Joint Surg Am","first-page":"89","article-title":"Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques","volume":"87","author":"Moshirfar","year":"2005","unstructured":"Moshirfar ARand FFSponseller PDPelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am. 2005;87(suppl 2):89-106."},{"key":"bib2","series-title":"World Neurosurg","first-page":"e296","article-title":"S2 alar-iliac screw insertion: technical note with pictorial guide","volume":"113","author":"Yilmaz","year":"2018","unstructured":"Yilmaz EAbdul-Jabbar ATawfik TS2 alar-iliac screw insertion: technical note with pictorial guide. World Neurosurg. 2018;113:e296-e301."},{"key":"bib3","series-title":"World Neurosurg","first-page":"408","article-title":"Comparison of complications and revisions after sacral 2 alar iliac screw and iliac screw fixation for sacropelvic fixation in pediatric and adult populations: systematic review and meta-analysis","volume":"132","author":"Keorochana","year":"2019","unstructured":"Keorochana GArirachakaran ASetrkraising KKongtharvonskul J.Comparison of complications and revisions after sacral 2 alar iliac screw and iliac screw fixation for sacropelvic fixation in pediatric and adult populations: systematic review and meta-analysis. World Neurosurg. 2019;132:408-420.e1."},{"issue":"3","key":"bib4","series-title":"Neurosurgery","first-page":"183","article-title":"Long-segment spinal fixation using pelvic screws","volume":"63","author":"Tumial\u00e1n","year":"2008","unstructured":"Tumial\u00e1n LMMummaneni PV.Long-segment spinal fixation using pelvic screws. Neurosurgery. 2008;63(3)(suppl):183-190."},{"issue":"12","key":"bib5","series-title":"Spine","first-page":"E439","article-title":"An anatomic study of the S2 iliac technique for lumbopelvic screw placement","volume":"34","author":"O'Brien","year":"2009","unstructured":"O'Brien JRYu WDBhatnagar RSponseller PKebaish KM.An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine. 2009;34(12):E439-E442."},{"issue":"1","key":"bib6","series-title":"J Orthop Surg Res","first-page":"136","article-title":"Three-dimensional digital anatomical measurement of modified sacroiliac screws","volume":"17","author":"Wang","year":"2022","unstructured":"Wang TZhao BYan JWang JChen CMu W.Three-dimensional digital anatomical measurement of modified sacroiliac screws. J Orthop Surg Res. 2022;17(1):136."},{"issue":"2","key":"bib7","series-title":"J Neurosurg Spine","first-page":"253","article-title":"Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis","volume":"30","author":"De la Garza","year":"2018","unstructured":"De la Garza RRNakhla JSciubba DMIliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis. J Neurosurg Spine. 2018;30(2):253-258."},{"issue":"3","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"E142","article-title":"Use of S2-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation","volume":"42","author":"Elder","year":"2017","unstructured":"Elder BDIshida WLo SLUse of S2-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine (Phila Pa 1976). 2017;42(3):E142-E149."},{"key":"bib9","series-title":"PeerJ","first-page":"e1587","article-title":"The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study","volume":"4","author":"Wu","year":"2016","unstructured":"Wu AMChi YLNi WFHuang YX.The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study. PeerJ. 2016;4:e1587."},{"key":"bib10","series-title":"World Neurosurg","first-page":"23","article-title":"S3 sacral-alar iliac screw: a salvage technique for pelvic fixation in complex deformity surgery","volume":"139","author":"Mattei","year":"2020","unstructured":"Mattei TA.S3 sacral-alar iliac screw: a salvage technique for pelvic fixation in complex deformity surgery. World Neurosurg. 2020;139:23-30."},{"issue":"2","key":"bib11","series-title":"Arch Orthop Trauma Surg","first-page":"177","article-title":"Morphometric measurement and applicable feature analysis of sacral alar\u2013iliac screw fixation using forward engineering","volume":"140","author":"Liu","year":"2020","unstructured":"Liu FYang YWen CMorphometric measurement and applicable feature analysis of sacral alar\u2013iliac screw fixation using forward engineering. Arch Orthop Trauma Surg. 2020;140(2):177-186."},{"issue":"3","key":"bib12","series-title":"J Neurosurg Spine","first-page":"367","article-title":"A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model","volume":"30","author":"Cunningham","year":"2019","unstructured":"Cunningham BWSponseller PDMurgatroyd AAKikkawa JTortolani PJ.A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model. J Neurosurg Spine. 2019;30(3):367-375."},{"issue":"4","key":"bib13","series-title":"Acta Orthop Traumatol Turc","first-page":"313","article-title":"Optimal trajectory and insertion accuracy of sacral alar iliac screws","volume":"51","author":"Yamada","year":"2017","unstructured":"Yamada KHigashi TKaneko KIde MSekiya TSaito T.Optimal trajectory and insertion accuracy of sacral alar iliac screws. Acta Orthop Traumatol Turc. 2017;51(4):313-318."},{"issue":"3","key":"bib14","series-title":"J Neurosurg Spine","first-page":"321","article-title":"Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: technical note","volume":"19","author":"Mattei","year":"2013","unstructured":"Mattei TAFassett DR.Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability: technical note. J Neurosurg Spine. 2013;19(3):321-330."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25267.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25267.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25267.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:10:22Z","timestamp":1769685022000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25267.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":28,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3171\/case25267","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]}}}