Pedicle axis view combined by sacral mapping can decrease fluoroscopic shot count in percutaneous iliosacral screw placement

Alemdaroğlu, Kadir Bahadır; Yücens, Mehmet; Kara, Talip; Gül, Deniz; Aydoğan, Nevres Hürriyet

doi:10.1016/j.injury.2014.10.048

Cited by 9 publications

(13 citation statements)

References 17 publications

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“…The specimens were placed on a radiolucent table in the supine position and Ziehm Solo (Ziehm, Nuremberg, Germany) fluoroscopy was used. Two fine intradermal K-wires (one horizontal and one vertical) were placed on the true lateral image, then using the mapping method, 8 the fluoroscopic lateral image was rotated and inverted if necessary, in order to equate the position of the image with the position of the sacrum of the cadaver specimen ( Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws?

Özmeriç

Yücens

Gültaç

et al. 2015

The Bone & Joint Journal

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We hypothesised that the anterior and posterior walls of the body of the first sacral vertebra could be visualised with two different angles of inlet view, owing to the conical shape of the sacrum. Six dry male cadavers with complete pelvic rings and eight dry sacrums with K-wires were used to study the effect of canting (angling the C-arm) the fluoroscope towards the head in 5° increments from 10° to 55°. Fluoroscopic images were taken in each position. Anterior and posterior angles of inclination were measured between the upper sacrum and the vertical line on the lateral view. Three authors separately selected the clearest image for overlapping anterior cortices and the upper sacral canal in the cadaveric models. The dry bone and K-wire models were scored by the authors, being sure to check whether the K-wire was in or out. In the dry bone models the mean score of the relevant inlet position of the anterior or posterior inclination was 8.875 (standard deviation (sd) 0.35), compared with the inlet position of the opposite inclination of -5.75 (sd 4.59). We found that two different inlet views should be used separately to evaluate the borders of the body of the sacrum using anterior and posterior inclination angles of the sacrum, during placement of iliosacral screws.

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Section: Methodsmentioning

confidence: 99%

Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws?

Özmeriç

Yücens

Gültaç

et al. 2015

The Bone & Joint Journal

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“… 19 44 2D navigation system — 62 ± 4 123 ± 12 Kadir et al . 20 7 Inlet, outlet, lateral view 31 — 138 10 Sacral pedicles view 30 — 52 Our study Normal sacrum group 31 Sacral pedicles axial view 37.8 ± 9.9 14 ± 5 50 ± 9 Dysmorphic sacrum group 27 42.4 ± 10.5 16 ± 4 53 ± 12 …”

Section: Resultsmentioning

confidence: 84%

Percutaneous Placement of Iliosacral Screws Under the Guidance of Axial View Projection of the S1 Pedicle: a Case Series

Yin

Hou

Zhang

et al. 2017

Sci Rep

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The aim of this study was to evaluate the safety and efficacy of percutaneous placement of iliosacral screws under the guidance of axial view projection of the S1 pedicle clinically. This case series includes 58 consecutive unstable pelvic injury patients, which were treated with iliosacral screws between July 2011 and July 2016. Patients were divided into two groups: normal sacrum (n = 31) and dysmorphic sacrum (n = 27). A single orthopedic surgeon operated on all patients, with percutaneous placement of iliosacral screws under the guidance of axial view projection of the S1 pedicle. The time needed for screw insertion and the radiation exposure time were recorded. Chi-squared test and Student t-test were used to analyze the differences between the two groups. Sacral dysmorphism was present in 47% of patients. The median time for screw insertion and radiation exposure time in these two groups showed no statistical difference (P > 0.05). No clinical complications or malpositioned screws occurred in any case. Preoperative pelvic CT is necessary to determine the sacral osseous anatomy. In patients with either a normal or dysmorphic sacrum, iliosacral screws can be placed by this method with less radiation exposure and complications than in the conventional method.

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“…In addition, based on the real-time images, which differed from the original inlet and outlet radiographs and CT scans [5,6,12,23], we could use these landmarks intraoperatively to control the screw trajectory and length because we set the ideal target points, the opposite curve point and the upper corner of S1, to achieve a fully intraosseous position along the entire path ( Figure 6).…”

Section: Figurementioning

confidence: 99%

“…Although iliosacral (IS) screw fixation has been widely used owing to biomechanical advantages, the technique is demanding because of the site's three-dimensional anatomical complexity, being close to neurovascular structures and having frequent upper sacral morphological variations [1][2][3]. Although the reported preoperative and intraoperative techniques [4][5][6] may aid in IS screw insertion, they require additional software for imaging and data analysis. Separately, although a safe and sufficient corridor for screw placement was also identified using preoperative planning [7][8][9], there is still the possibility of extraosseous screw placement because of misinterpreted fluoroscopic imaging or incorrect technical execution [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, although preoperative planning could verify sufficient bone corridors, screws could be placed eccentric to the ideal or planned locations, and thus, most surgeons preferred intraoperative implementation by fluoroscopic landmarks that were easily visualized by standard techniques and enabled surgeons to control the screw trajectory in real time. Surgical techniques have now changed based on improved understanding of posterior pelvic radiographic anatomy to enable clearer visualization of safe corridors during fluoroscopically guided IS screw placement [5,7,12]. In this study, we introduce relevant landmarks for the successful use of the fluoroscopic inlet and outlet views to verify safe screw trajectories when placing percutaneous IS screws.…”

Section: Introductionmentioning

confidence: 99%

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Successful Use of Fluoroscopic Inlet and Outlet Views to Verify Safe Screw Trajectories when Placing Percutaneous Iliosacral Screws

Kwak¹,

Heo²,

Jung³

2018

Med Case Rep J

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The purpose of this study was to introduce practical landmarks for the successful use of the fluoroscopic inlet and outlet views to verify safe screw trajectories when placing percutaneous iliosacral (IS) screws. Materials and Methods: A total of 10 sacra (19 hemi-sacra) from cadavers without gross deformity or previous injury were included in this study. The upper boundaries and S1 were marked with 1 mm lead wire. The marked sacra were positioned on a radiolucent operative table similar to the operative supine position and projected into the pelvic inlet and outlet views and the true lateral view of the pelvis via an image intensifier. Using image editing software, fluoroscopic images were analyzed to identify the fluoroscopic landmarks and ideal entry points. Results: The posterior-superior corner of the lateral articular surface was constantly projected as a curve point in the pelvic inlet view, and the imaginary connecting line between two points did not violate the posterior walls of S1 in any of the sacra with a little space. Based on the curve points, screws had to be directed either straight or anteriorly (range: 18.3°-29.6°) on inlet view. On outlet view, the ideal screw trajectory was the imaginary oblique line from the height of the S1 foramen to the opposite upper corner of S1 (range: 15.5°-24.4°) and the sacral ala was not violated. Conclusion: For successful fluoroscopy, two simple landmarks could be utilized, the imaginary connecting line between the two curve points in the pelvic inlet view and the oblique screw trajectory toward the opposite corner of S1 in the pelvic outlet view, using the standard technique and irrespective of sacral dysplasia.

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Pedicle axis view combined by sacral mapping can decrease fluoroscopic shot count in percutaneous iliosacral screw placement

Cited by 9 publications

References 17 publications

Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws?

Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws?

Percutaneous Placement of Iliosacral Screws Under the Guidance of Axial View Projection of the S1 Pedicle: a Case Series

Successful Use of Fluoroscopic Inlet and Outlet Views to Verify Safe Screw Trajectories when Placing Percutaneous Iliosacral Screws

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