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

Yingchao Yin,Wei Chen,Yingze Zhang,Lin Jin,Ruipeng Zhang,Zhiyong Hou

doi:10.1038/s41598-017-08262-w

Abstract

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.

Highlights

The conventional method used to accomplish the percutaneous insertion of iliosacral screws derives mainly from the technique described by Matta and Saucedo[1] and Routt et al.[3], in which C-arm fluoroscopy is used to visualize the pelvis in three views: inlet, outlet and true lateral views
47% of patients had sacral dysmorphism. All patients in both the normal and dysmorphic sacrum groups had iliosacral screws successfully inserted under the guidance of the axial view projection of the S1 pedicle
There was no significant difference between groups in operating time per screw and radiation exposure time, both parameters were reduced compared with previous studies[4, 15,16,17,18,19,20]

Summary

Introduction

The conventional method used to accomplish the percutaneous insertion of iliosacral screws derives mainly from the technique described by Matta and Saucedo[1] and Routt et al.[3], in which C-arm fluoroscopy is used to visualize the pelvis in three views: inlet, outlet and true lateral views. To position the iliosacral screws speedily and efficiently, Hou et al described a new technique of iliosacral screw placement with C-arm fluoroscopy visualizing the pedicle view of S1, which was shown to be efficient and safe in cadavers[11]. The present investigation was designed to prove that the sacral pedicle axial view projection is an optimal and practical radiographic technique for percutaneous placement of iliosacral screws clinically

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