Percutaneous Placement of Iliosacral Screws Without Electrodiagnostic Monitoring

Abstract

Using a standardized technique, appropriate and reliable fluoroscopic landmarks are available in the vast majority of percutaneous iliosacral screw fixation procedures. Iliosacral screw placement without neurodiagnostic monitoring has a low rate of neurologic complications.

Anatomic Determinants of Sacral Dysmorphism and Implications for Safe Iliosacral Screw Placement

“…Ten millimeters was chosen to provide 1 to 2 mm of circumference around a 6.3 to 8-mm-diameter screw, and has been previously established as a reasonably ''safe''-diameter corridor by experienced surgeons 4,29,37 . The smallest cross-sectional area that we measured in a first sacral osseous corridor was 206 mm 2 . In comparison, an 8-mm iliosacral screw has a cross-sectional area of 50.2 mm 2 .…”

“…Other studies have shown that patients with all of these characteristics have a more narrow and angled osseous corridor in the first sacral segment compared with those who exhibit none of these characteristics 23,28,29 . Using these criteria to adjust operative planning, surgeons can achieve percutaneous fixation of pelvic fractures with low rates of neurovascular injury, ranging from 0% to 1% 2,6 . We studied a large cohort of uninjured pelves to represent the variance in morphology within the general population.…”

“…A change in trajectory of only 4°can result in cortical perforation 22 . Concise understanding of this aspect of sacral anatomy and its corresponding fluoroscopic landmarks enables safe placement of percutaneous iliosacral screws 2,[23][24][25][26] .…”

“…The sacral dysmorphism score quantifies dysmorphism and can be used in preoperative planning of iliosacral screw placement. P ercutaneous iliosacral screw fixation has been widely adopted as a safe method for treatment of unstable pelvic ring injuries [1][2][3][4][5][6][7] . The use of iliosacral screws is increasing, probably as a result of increased training in the technique, an increase in the incidence of pelvic ring injuries, and increased survival of patients with unstable pelvic ring injuries 8,9 .…”

Evaluation and Clinical Application of Sacral S1 Vestibule Measurements in Chinese Adults

“…Many fixation methods are currently used to treat posterior pelvic ring injuries clinically (Sagi et al, 2004;Schildhauer et al, 2002Schildhauer et al, , 2003Yinger et al, 2003;Ziran et al, 2003;Vanderschot et al, 2001;Kobbe et al, 2012), and the iliosacral screw (ISS) technique (Ponsen et al, 2006) has been widely used (Cole et al, 1996;Shuler et al, 1995;Sciulli et al, 2007;Gardner & Chip Routt, 2010;Gardner et al, 2009;Zwingmann et al, 2010;Kim et al, 2012;Oh et al, 2008) because of its reliable fixation strength, small wound, decreased bleeding, and low infection rate. Mears & Velyvis (2003) described the pelvis as a "three-column structure."…”