Abstract
Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.
Highlights
Fractures of the pelvic ring are severe injuries, which occur with an incidence between 0.3 to 8.0% of all fractures [1]
The identification of the perfect safe osseous corridor was reproducible in each preoperative computed tomography (CT) scan (Figure 1)
The fusion of CT slices by means of the thick slab function of OsiriX MD resulted in true lateral two-dimensional images, which were transferable to intraoperative fluoroscopy (Figure 2)
Summary
Fractures of the pelvic ring are severe injuries, which occur with an incidence between 0.3 to 8.0% of all fractures [1]. A widely used, minimal invasive technique to stabilize the posterior pelvic ring is a sacroiliac screw fixation (SI screws) [3]. Intraoperative visualization of ideal screw placement is challenging, especially in the case of sacral dysmorphisms, which can result in narrow or oblique osseous corridors [5,7,11,12,13,14,15,16,17,18] This is in accordance with Tonetti et al, who described this technique by means of intraoperative fluoroscopy as successful, but very challenging due to the importance of exact x-ray positioning for inlet/outlet and strict lateral view [19]. In cases where there is no intraoperative 3D navigation available, application of a three-dimensional planned screw position to an intraoperative, fluoroscopic two-dimensional image may be helpful
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