Placement of percutaneous iliosacral screws under computed tomographic guidance

Abstract

This report discusses the technique and results of computed tomographic-guided placement of sacroiliac screws using only conscious sedation and local anesthesia. Previous literature found logistic problems with sterility and adequate anesthesia. We have developed and refined the technique of placing sacroiliac screws with a local prep and portable equipment. This technique allows placement of screws in positions not previously accessible with standard fluoroscopic methods and is 100% accurate. There are no visualization problems and variations in lumbosacral morphology or sacral dysmorphism does not preclude its use. In unstable and disiplaced fractures, a preliminary reduction of the anterior pelvis with either an external fixator or plating will often reduce the posterior pelvis to the extent that minor improvements of reduction are possible with reduction screws. There were no adverse events associated with the technique, and a cost analysis found significant savings when compared with intraoperative placement using fluoroscopy. To date, we have not identified any other literature using this particular method, and we find it to be quite useful, safe, and accurate for the indicated patients.