Is pelvic mapping applicable in iliosacral screw fixation to determine screw entry point and screw trajectory?

Durusoy, Serhat; Paksoy, Ahmet Emre; Korkmaz, Murat; Solak, Ahmet Şükrü; Dağlar, Bülent

doi:10.5606/ehc.2019.66489

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…It should be remembered that there are morphological changes in the sacrum described as normal. We can see this best in the study conducted by Goetzen et al (15). In this study, it is reported that the screw insertion location may change depending on the sacrum types, especially in the lateral projection.…”

Section: Discussionmentioning

confidence: 79%

The Importance of Sacrum Morphology in Transsacral and Iliosacral Screw Fixation

Durusoy

Paksoy

2021

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi

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Section: Discussionmentioning

confidence: 79%

The Importance of Sacrum Morphology in Transsacral and Iliosacral Screw Fixation

Durusoy

Paksoy

2021

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi

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“…Several researchers have attempted to define a safe starting point on the sacral lateral view. Durusoy et al defined a starting point located in the shadow of the S1 sacral canal, which was posterior to the sacral body 7 . Javidmehr et al chose the posteroinferior quadrant of the anterosuperior quadrant of the S1 body to set the starting point 8 .…”

Section: Discussionmentioning

confidence: 99%

“…The reasoning is that the ICD serves to indicate the slope of the sacral ala, allowing it to serve as a reliable guide that prevents anterior penetration of the sacrum, which would endanger the L5 nerve root 5,6 . Notably, the S1 shadow (which is posteroinferior to the ICD) is a region (rather than a specific point) in which the SI iliosacral screw starting point can be set at the surgeons' discretion [7][8][9][10][11] , which limits the reproducibility of the procedure. Given that sacral dysmorphism (Fig.…”

mentioning

confidence: 99%

Specifying the Starting Point for S1 Iliosacral Screw Placement in the Dysmorphic Sacrum

Cai,

Zhang,

Yin

et al. 2023

Journal of Bone and Joint Surgery

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Background: Sacral dysmorphism is not uncommon and complicates S1 iliosacral screw placement partially because of the difficulty of determining the starting point accurately on the sacral lateral view. We propose a method of specifying the starting point. Methods: The starting point for the S1 iliosacral screw into the dysmorphic sacrum was specifically set at a point where the ossification of the S1/S2 intervertebral disc (OSID) intersected the posterior vertebral cortical line (PVCL) on the sacral lateral view, followed by guidewire manipulation and screw placement on the pelvic outlet and inlet views. Computer-simulated virtual surgical procedures based on pelvic computed tomography (CT) data on 95 dysmorphic sacra were performed to determine whether the starting point was below the iliac cortical density (ICD) and in the S1 oblique osseous corridor and to evaluate the accuracy of screw placement (with 1 screw being used, in the left hemipelvis). Surgical procedures on 17 patients were performed to verify the visibility of the OSID and PVCL, to check the location of the starting point relative to the ICD, and to validate the screw placement safety as demonstrated with postoperative CT scans. Results: In the virtual surgical procedures, the starting point was consistently below the ICD and in the oblique osseous corridor in all patients and all screws were Grade 1. In the clinical surgical procedures, the OSID and PVCL were consistently visible and the starting point was always below the ICD in all patients; overall, 21 S1 iliosacral screws were placed in these 17 patients without malpositioning or iatrogenic injury. Conclusions: On the lateral view of the dysmorphic sacrum, the OSID and PVCL are visible and intersect at a point that is consistently below the ICD and in the oblique osseous corridor, and thus they can be used to identify the starting point. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…[ 9 , 10 ] However, patients may be prone to develop complications due to some factors, including variability in pelvic anatomy, the narrowness of the bone corridor to be screwed, and inadequacies in imaging and surgical procedures. [ 11 ] In the literature, the current technique has been modified by combining with different imaging techniques in order to decrease the complication rates and increase surgical success. Computed tomography (CT) and computerized navigation systems are the most common combinations introduced for this purpose.…”

Section: Introductionmentioning

confidence: 99%

Do three-dimensional modeling and printing technologies have an impact on the surgical success of percutaneous transsacral screw fixation?

2020

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Caused by high-energy traumas, pelvic injuries are life-threatening complex injuries posing several unfavorable effects on the body. Pelvic fractures account for approximately 3-4.3% of all skeletal fractures. [1,2] Mortality rates due to pelvic injuries vary from 10 to 16%. [1,3] Victims of these injuries display an increased tendency to develop complications due to the nature of the injury and modes of treatment. [4-8] Complications are critical for patient survival and sequelae development. Percutaneous iliosacral and transsacral-transiliac screw fixation are the commonly preferred surgical methods for the treatment of posterior pelvic injuries. The advantages of this technique include minimal tissue damage due to the surgical procedure, improved stability of the fixation, short surgery time, and reduced risk for wound-related problems in the postoperative period. [9,10] However, patients may be prone to develop complications due to some factors, including variability in pelvic anatomy, the narrowness of the bone corridor to be screwed, and inadequacies in imaging and Objectives: This study aims to determine the role of computed tomography (CT)-derived templates, produced by threedimensional (3D) modeling, image processing and printing technology, in percutaneous transsacral screw fixation and evaluate the effects of their use on surgical success. Materials and methods: This prospective study conducted between June 2018 and December 2019 utilized 15 composite pelvis models for transsacral-transiliac screw fixation. For the procedure, modeled templates were utilized for wiring on the left side of the pelvis models, while the conventional method was performed on the right side of the pelvis models. In the computed tomography images acquired after wiring, appropriate wire position was evaluated. Results: The placed wires held the S1 body appropriately in all of the procedures with or without template use. With the template use, the wires were placed appropriately in the surgical bone corridor suitable for the transsacral-transiliac screw fixation in all of the models. However, with the conventional methods, the wires were not placed in the safe surgical bone corridor in four models. The wire deviation angle in the axial plane was significantly lower in the template group (p=0.001), whereas it was not different between the template group and the conventional method group in the coronal plane (p=0.054). The amount of deviation from the ideal wire entry site was significantly reduced in the template group compared to the conventional method group (p=0.001). Conclusion: With the use of 3D modeling and printing technology, CT-derived templates can be produced and utilized for transsacral screw fixation procedures and their use increases surgical success by reducing the surgical margin of error.

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Is pelvic mapping applicable in iliosacral screw fixation to determine screw entry point and screw trajectory?

Cited by 3 publications

References 23 publications

The Importance of Sacrum Morphology in Transsacral and Iliosacral Screw Fixation

The Importance of Sacrum Morphology in Transsacral and Iliosacral Screw Fixation

Specifying the Starting Point for S1 Iliosacral Screw Placement in the Dysmorphic Sacrum

Do three-dimensional modeling and printing technologies have an impact on the surgical success of percutaneous transsacral screw fixation?

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