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Sacropelvic fixation is frequently used for the correction of complex pediatric spine deformities. S2-alar-iliac (S2AI) screws are a powerful method to obtain iliac fixation. Advantages include a medialized starting point that requires less soft tissue dissection, no need for connectors to the rod, and reduced screw head prominence. Though the technique for S2AI placement under free-hand and fluoroscopic techniques has been described, there is limited description of computed tomography (CT)-guided technique for the placement of S2AI screws in pediatric patients undergoing surgery for complex spinal deformity. The goal of this paper is to describe the technique for placement of S2AI screws via CT-guided navigation and compare it to traditional fluoroscopy and free-hand techniques.