Dual iliac screws in spinopelvic fixation: a systematic review

  • Anouar BourghliEmail author
  • Louis Boissiere
  • Ibrahim Obeid
Review Article



The classical spinopelvic fixation includes 1 iliac screw on each side. The purpose of this study is to specify the indications of the “dual iliac screw” (DIS) construct, i.e., when to put 2 iliac screws on each side, to describe its biomechanical advantages, and to define its related technical aspects.


A primary search on Medline through PubMed distribution was performed, with the use of the terms “pelvic fixation” or “spinopelvic” or “lumbo-iliac” and the terms “dual iliac screw” or “double iliac screw.” English papers corresponding to the inclusion criteria were analyzed regarding the specific indications of the DIS construct and its surgical technique and advantages.


Eleven papers were identified according to the research criteria and included in this review. Three main indications were identified for the DIS technique according to three types of pathologies: in adult deformities when a long construct is needed in an osteoporotic patient or when correction requires three-column osteotomy of the sacrum; in trauma when a U-shaped fracture–dislocation of the sacrum is involved; in sacral tumors when a sacrectomy is performed or when destructive metastatic lesions of the sacrum require palliative surgical treatment. Biomechanically, the DIS technique proved to have higher construct stiffness in terms of compression and torsion.


In specific cases, affecting different areas of spinal diseases, the DIS technique is more advantageous, when compared to the “single iliac screw” version, as it would provide a stronger and safer fixation at the base of the spinopelvic construct.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Dual iliac screws Sacral U-shaped fracture S1 pedicle subtraction osteotomy Sacral tumor Osteoporotic adult spinal deformity 


Compliance with ethical standards

Conflict of interest

There are no conflicts of interest for this article.

Supplementary material

586_2019_6065_MOESM1_ESM.pptx (612 kb)
Supplementary material 1 (PPTX 612 kb)


  1. 1.
    Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG (2001) Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:1976–1983CrossRefGoogle Scholar
  2. 2.
    Moshirfar A, Rand FF, Sponseller PD, Parazin SJ, Khanna AJ, Kebaish KM, Stinson JT, Riley LH 3rd (2005) Pelvic fixation in spine surgery Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg Am 87(Suppl 2):89–106. Google Scholar
  3. 3.
    Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque–Galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976) 27:776–786CrossRefGoogle Scholar
  4. 4.
    Chang TL, Sponseller PD, Kebaish KM, Fishman EK (2009) Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine (Phila Pa 1976) 34:436–440. CrossRefGoogle Scholar
  5. 5.
    Yu BS, Zhuang XM, Zheng ZM, Li ZM, Wang TP, Lu WW (2010) Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct. Eur Spine J 19:1121–1128. CrossRefGoogle Scholar
  6. 6.
    Hasan MY, Liu G (2017) Minimally invasive dual iliac screw, dual rod fixation in a rare case of pathological sacral fracture from a paraganglionoma: a technique description. J Neurosurg Spine 27:316–320. CrossRefGoogle Scholar
  7. 7.
    Yu BS, Zhuang XM, Li ZM, Zheng ZM, Zhou ZY, Zou XN, Lu WW (2010) Biomechanical effects of the extent of sacrectomy on the stability of lumbo-iliac reconstruction using iliac screw techniques: what level of sacrectomy requires the bilateral dual iliac screw technique? Clin Biomech (Bristol, Avon) 25:867–872. CrossRefGoogle Scholar
  8. 8.
    Fujibayashi S, Neo M, Nakamura T (2007) Palliative dual iliac screw fixation for lumbosacral metastasis. Technical note. J Neurosurg Spine 7:99–102. CrossRefGoogle Scholar
  9. 9.
    Mindea SA, Chinthakunta S, Moldavsky M, Gudipally M, Khalil S (2012) Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy. Spine (Phila Pa 1976) 37:E1622–E1627. CrossRefGoogle Scholar
  10. 10.
    Acharya NK, Bijukachhe B, Kumar RJ, Menon VK (2008) Ilio-lumbar fixation—the Amrita technique. J Spinal Disord Tech 21:493–499. CrossRefGoogle Scholar
  11. 11.
    Ebata S, Ohba T, Oba H, Haro H (2018) Bilateral dual iliac screws in spinal deformity correction surgery. J Orthop Surg Res 13:260. CrossRefGoogle Scholar
  12. 12.
    Vilela MD, Gelfenbeyn M, Bellabarba C (2009) U-shaped sacral fracture and lumbosacral dislocation as a result of a shotgun injury: case report. Neurosurgery 64:E193–E194. (Discussion E194) CrossRefGoogle Scholar
  13. 13.
    Bodin A, Roussouly P (2015) Sacral and pelvic osteotomies for correction of spinal deformities. Eur Spine J 24(Suppl 1):S72–S82. CrossRefGoogle Scholar
  14. 14.
    Ozturk AK, Sullivan PZ, Arlet V (2018) Sacral pedicle subtraction osteotomy for an extreme case of positive sagittal balance: case report. J Neurosurg Spine 28:532–535. CrossRefGoogle Scholar
  15. 15.
    Czyz M, Forster S, Holton J, Shariati B, Clarkson DJ, Boszczyk BM (2017) New method for correction of lumbo-sacral kyphosis deformity in patient with high pelvic incidence. Eur Spine J 26:2204–2210. CrossRefGoogle Scholar
  16. 16.
    Konig MA, Jehan S, Boszczyk AA, Boszczyk BM (2012) Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J 21:829–836. CrossRefGoogle Scholar
  17. 17.
    Zhang HY, Thongtrangan I, Balabhadra RS, Murovic JA, Kim DH (2003) Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus 15:E5CrossRefGoogle Scholar
  18. 18.
    Bederman SS, Shah KN, Hassan JM, Hoang BH, Kiester PD, Bhatia NN (2014) Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J 23:305–319. CrossRefGoogle Scholar
  19. 19.
    Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V, International Spine Study G (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803–E812. CrossRefGoogle Scholar
  20. 20.
    Obeid I, Bourghli A, Boissiere L, Vital JM, Barrey C (2014) Complex osteotomies vertebral column resection and decancellation. Eur J Orthop Surg Traumatol 24(Suppl 1):S49–S57. CrossRefGoogle Scholar
  21. 21.
    Hak DJ, Baran S, Stahel P (2009) Sacral fractures: current strategies in diagnosis and management. Orthopedics. Google Scholar
  22. 22.
    O’Brien JR, Yu WD, Bhatnagar R, Sponseller P, Kebaish KM (2009) An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine (Phila Pa 1976) 34:E439–E442. CrossRefGoogle Scholar
  23. 23.
    Shen FH, Mason JR, Shimer AL, Arlet VM (2013) Pelvic fixation for adult scoliosis. Eur Spine J 22(Suppl 2):S265–S275. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anouar Bourghli
    • 1
    Email author
  • Louis Boissiere
    • 2
  • Ibrahim Obeid
    • 2
  1. 1.Orthopedic and Spinal Surgery DepartmentKingdom HospitalRiyadhSaudi Arabia
  2. 2.Orthopedic Spinal Surgery Unit 1Bordeaux Pellegrin HospitalBordeauxFrance

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