Abstract
ABSTRACT Objective: To evaluate the morphometry of the pelvis to determine the safe trajectory for the insertion of the S2-iliac screw, and to correlate it with studies reported in the literature for other populations. Method: The computed tomography (CT) pelvic exams of 36 Brazilian patients without congenital malformations, tumors, pelvic ring fractures or dysplasias were selected from the database of a radiological clinic. To define the ideal trajectory of the S2-iliac screw, the following variables were measured: 1- maximum sacroiliac screw length; 2- thickness of the iliac dipole for planning the choice of screw dimensions (length and diameter); 3 - distance between the insertion point of the iliac S2 screw and the posterior sacral cortex; 4 - angulation for insertion of the screw in the mediolateral direction, representing the angle formed between the “iliac line” and the anatomical sagittal plane; 5- Angulation for insertion of the screw in the craniocaudal direction. The Pearson's chi squared and student's t tests were used for statistical analysis. Results: The sample consisted of 36 patients, 50% (18/36) of whom were women. The mean age was 63.7 years, ranging from 23 to 96 years. All the pelvic morphometric variables analyzed presented values similar to those described in the literature for other populations. Conclusion: Prior evaluation of the tomography exams was important for preoperative planning, and there was a statistically significant difference between the sexes only in relation to the variables left craniocaudal and length of the left internal table. Level of evidence III; Observational cross-sectional study.
Highlights
Despite technological advances, pelvic fixation continues to be a big challenge for the spine surgeon
To evaluate the morphometry of the pelvis to determine the safe trajectory for the insertion of the S2-iliac screw, and to correlate it with studies reported in the literature for other populations
Due to the absence of national studies on the anatomical theme of the ideal trajectory of the S2 iliac screw, for the Brazilian population, the objective of this study is to describe the autochthonous pelvimetric parameters and to determine the measures of central tendency of the parameters used by the spine surgeon to assist them when inserting the S2 alar-iliac (S2AI) screw
Summary
Pelvic fixation continues to be a big challenge for the spine surgeon. Kim et al demonstrated that, in cases of long instrumentations, distal fixations with sacral pedicle screws have high rates of mechanical complications. As a result, they suggest using some form of complementary fixation when lumbopelvic instrumentation is necessary.[3]. Sponseller et al determined the best trajectory for S2AI screws using pelvic CT.[10] To date, only international studies have measured pelvimetric parameters in their respective populations Some of these studies have reported important anatomical variations for the definition of ideal S2 iliac screw positioning.[16,17,18]. Due to the absence of national studies on the anatomical theme of the ideal trajectory of the S2 iliac screw, for the Brazilian population, the objective of this study is to describe the autochthonous pelvimetric parameters and to determine the measures of central tendency of the parameters used by the spine surgeon to assist them when inserting the S2AI screw
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