Use of the S2 iliac technique may be a viable option in minimally invasive thoracolumbar deformity surgery. The screws were all in-line and connected easily to the cephalad instrumentation. On average, a length of approximately 90 mm was attained. No visceral or neurovascular structure was injured. Visualization of the first dorsal foramen and a standard anteroposterior and inlet radiograph were used for placement.

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Multiple techniques of pelvic fixation exist. Distal fixation to the pelvis is crucial for spinal deformity surgery. Fixation techniques such as transiliac bars, iliac bolts, and iliosacral screws are commonly used, but these techniques may require separate incisions for placement, leading to potential wound complications and increased dissection. Additionally, the use of transverse connector bars is almost always necessary with these techniques, as their placement is not in line with the S-1 pedicle screw and cephalad instrumentation. The S-2 alar iliac pelvic fixation is a newer technique that has been developed to address some of these issues. It is an in-line technique that can be placed during an open procedure or percutaneously.

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