Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation

Abstract

This study demonstrates that MIO fixation of canine sacroiliac luxations provides more accurate and consistent sacral screw placement than ORIF. With proper techniques, iatrogenic neurological damage can be avoided with both techniques. The PL /SW-R, which relates to safe screw fixation, also demonstrates that screw penetration of at least 60% of the sacral width is achievable regardless of surgical approach. These findings, along with the limited dissection needed for accurate sacral screw placement, suggest that MIO of sacroiliac luxations is a valid alternative to ORIF.

Outcomes for 15 cats with bilateral sacroiliac luxation treated with transiliosacral toggle suture repair

“…29 Recent studies highlighted the interest of fluoroscopically guided techniques in the treatment of SILF in dogs and cats, which are associated with better anatomical reduction and implant positioning, as well as less implant loosening than conventional open techniques. 5,6,12,14,18,19,31,[37][38][39][40] Surgical time also appears subjectively shorter with closed reduction and lag screw fixation of unilateral SILF (6-16 minutes). [38][39][40] The technique described in our study could potentially be performed with a minimally invasive approach under fluoroscopic guidance.…”

“…Surgical stabilization of pelvic floor factures has been reported in cats and could also be performed towards achieving an even better and faster mechanical and functional recovery 29 . Recent studies highlighted the interest of fluoroscopically guided techniques in the treatment of SILF in dogs and cats, which are associated with better anatomical reduction and implant positioning, as well as less implant loosening than conventional open techniques 5,6,12,14,18,19,31,37–40 . Surgical time also appears subjectively shorter with closed reduction and lag screw fixation of unilateral SILF (6–16 minutes) 38–40 .…”

“…Drilling through the sacral body is technically challenging, with a limited safe corridor, especially for less experienced surgeons and without intraoperative fluoroscopic guidance. [5][6][7][8][9][10][11][12] When the condition is bilateral, the simultaneous approach of both the sacroiliac joint and, especially, the sacral wings and the use of an aiming device can enable this technical challenge to be overcome. Previous studies reported the use of a single transiliosacral screw, pin, rod, or screw and nut as treatment of bilateral sacroiliac luxation.…”

“…Surgical management of bilateral SILF consists of stabilization with implants that can either be transiliosacral, transilial craniodorsally to the sacrum, or bilateral iliosacral. Drilling through the sacral body is technically challenging, with a limited safe corridor, especially for less experienced surgeons and without intraoperative fluoroscopic guidance 5–12 . When the condition is bilateral, the simultaneous approach of both the sacroiliac joint and, especially, the sacral wings and the use of an aiming device can enable this technical challenge to be overcome.…”

Defining a safe corridor for trans‐iliac pin placement in cats

“…SI lag screw placement can be technically challenging and potentially high risk, leading to many specialists preferring intraoperative imaging and novel instruments to improve their accuracy. 19,21,22 Trans-iliac pin placement, however, requires a less extensive surgical approach and fewer orthopaedic tools and has a lower risk of damaging the caudal sacral plexus or penetrating the intervertebral canal due to the smaller diameter of the pin. A trans-iliac pin may be an alternative to SI lag screws; however, a safe corridor for this type of implant has not been defined before.…”