Safe Corridor for Sacroiliac Screw Insertion Can Be Found Quickly Without the Use of the Lateral Sacral View

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedics, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran

2 Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background:Studies have proved that in addition to the inlet and outlet views, the intraoperative lateral sacral view
is required to ensure the correct entry point, reduce operating time, and lower radiation exposure. Considering the
complex anatomy of the sacrum, we showed a safe corridor for sacroiliac joint (SIJ) screw insertion that was accessible
using only inlet and outlet fluoroscopic views.
Methods: From 2013 to 2020, we enrolled 215 patients who underwent percutaneous SIJ screw insertion. Our
experience in SIJ screw insertion is presented using only two views (inlet and outlet). We reported on the radiation
exposure time, operating time, rate of screw malposition, neurologic injury, and revision surgery.
Results: The screw malposition rate was 5.5%, including 11 foraminal perforations and one perforated anterior sacral
cortex. Paresthesia after the surgery was observed in six patients (2.8%). No revision surgery or screw removal was
performed. The radiation exposure and operation time for each screw were 21 ± 4.5 s and 13.5 min, respectively.
Conclusion: The most anterior and the lowest part of the S1 vertebra can be easily found using intraoperative inlet
and outlet views. It is a safe corridor for SIJ screw insertion with low radiation time, neurologic injury, and revision rates.
Level of evidence: IV

Keywords

References

  1. Iorio JA, Jakoi AM, Rehman S. Percutaneous Sacroiliac Screw Fixation of the Posterior Pelvic Ring. Orthop Clin North Am. 2015 Oct;46(4):511-21. PubMed PMID: 26410639. Epub 2015/09/28. eng.
  2. Krappinger D, Lindtner RA, Benedikt S. Preoperative planning and safe intraoperative placement of iliosacral screws under fluoroscopic control. Operative Orthopadie und Traumatologie. 2019 Dec;31(6):465-73. PubMed PMID: 31161245. Pubmed Central PMCID: PMC6879436. Epub 2019/06/05. Präoperative Planung und sichere intraoperative bildwandlerkontrollierte sakroiliakale Schraubenapplikation. eng.
  3. Miller AN, Routt Jr MLC. Variations in sacral morphology and implications for iliosacral screw fixation. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2012;20(1):8-16.
  4. Collinge C, Coons D, Aschenbrenner J. Risks to the superior gluteal neurovascular bundle during percutaneous iliosacral screw insertion: an anatomical cadaver study. J Orthop Trauma. 2005 Feb;19(2):96-101. PubMed PMID: 15677925. Epub 2005/01/29. eng.
  5. Lu S, Yang K, Lu C, Wei P, Gan Z, Zhu Z, et al. O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury. Int Orthop. 2021 Feb 17. PubMed PMID: 33594466. Epub 2021/02/18. eng.
  6. Kim CH, Kim JW. Plate versus sacroiliac screw fixation for treating posterior pelvic ring fracture: a Systematic review and meta-analysis. Injury. 2020 Oct;51(10):2259-66. PubMed PMID: 32646648. Epub 2020/07/11. eng.
  7. Tidwell J, Cho R, Reid JS, Boateng H, Copeland C, Sirlin E. Percutaneous Sacroiliac Screw Technique. J Orthop Trauma. 2016 Aug;30 Suppl 2:S19-20. PubMed PMID: 27441927. Epub 2016/07/22. eng.
  8. Rommens PM, Nolte EM, Hopf J, Wagner D, Hofmann A, Hessmann M. Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study. European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2020 Apr 15. PubMed PMID: 32296862. Epub 2020/04/17. eng.
  9. Giannoudis PV, Papadokostakis G, Alpantaki K, Kontakis G, Chalidis B. Is the lateral sacral fluoroscopic view essential for accurate percutaneous sacroiliac screw insertion? An experimental study. Injury. 2008 Aug;39(8):875-80. PubMed PMID: 18550059. Epub 2008/06/14. eng.
  10. Zwingmann J, Konrad G, Kotter E, Südkamp NP, Oberst M. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res. 2009 Jul;467(7):1833-8. PubMed PMID: 19034594. Pubmed Central PMCID: PMC2690740. Epub 2008/11/27. eng.
  11. Tonetti J, Carrat L, Blendea S, Merloz P, Troccaz J, Lavallée S, et al. Clinical results of percutaneous pelvic surgery. Computer assisted surgery using ultrasound compared to standard fluoroscopy. Computer aided surgery : official journal of the International Society for Computer Aided Surgery. 2001;6(4):204-11. PubMed PMID: 11835615. Epub 2002/02/09. eng.
  12. van den Bosch EW, van Zwienen CM, van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma. 2002 Jul;53(1):44-8. PubMed PMID: 12131388. Epub 2002/07/20. eng.
  13. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002 Feb(395):135-44. PubMed PMID: 11937873. Epub 2002/04/09. eng.
  14. Zwingmann J, Hauschild O, Bode G, Südkamp NP, Schmal H. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Archives of orthopaedic and trauma surgery. 2013 Sep;133(9):1257-65. PubMed PMID: 23748798. Epub 2013/06/12. eng.
  15. Konrad G, Zwingmann J, Kotter E, Südkamp N, Oberst M. Variability of the screw position after 3D-navigated sacroiliac screw fixation. Influence of the surgeon’s experience with the navigation technique. Der Unfallchirurg. 2010;113(1):29-35.
  16. Yu T, Cheng XL, Qu Y, Dong RP, Kang MY, Zhao JW. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases. 2020 Jun 26;8(12):2464-72. PubMed PMID: 32607323. Pubmed Central PMCID: PMC7322419. Epub 2020/07/02. eng.
  17. Wu C, Deng J-y, Li T, Tan L, Yuan D-c. Combined 3D Printed Template to Guide Iliosacral Screw Insertion for Sacral Fracture and Dislocation: A Retrospective Analysis. Orthopaedic Surgery. 2020;12(1):241-7.
The Archives of Bone and Joint Surgery
Volume 10, Issue 11
November 2022
Pages 959-963

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History

  • Receive Date: 02 September 2021
  • Revise Date: 13 March 2022
  • Accept Date: 14 March 2022

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