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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-09-2016 | Trauma Surgery

A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation

Authors: Michael Goetzen, Kevin Ortner, Richard A. Lindtner, Rene Schmid, Michael Blauth, Dietmar Krappinger

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2016

Abstract

Background

Percutaneous sacroiliac screw fixation under fluoroscopic control is an effective method for posterior pelvic ring stabilization. However, sacral dysmorphism has a high risk of L5 nerve injury. This study describes a simple method for the preoperative assessment of the sacral morphology using CT scans with widely available tools.

Materials and methods

CT scans of 1000 patients were analyzed. True inlet, outlet, and lateral views of the sacrum were obtained using a two-dimensional reconstruction tool to align the sacrum in a reproducible manner. Corridor morphology in the inlet view was measured to calculate different morphological types: (1) Ascending type, (2) Horizontal type, and (3) Descending type. In a second step, the corridor was analyzed for the presence of an anterior indentation of the sacrum between the SI joint and the midsagittal plane with proximity to the nerve root L5, which, therefore, may be harmed during screw misplacement.

Results

A notch was found in the majority of cases with relative frequencies ranging from 69 % (upper quartile of S1) to 95 % (upper quartile of S2). Descending types were, by far, the most frequent corridor type with one exception: In the upper quartile of S1, the ascending type was the most frequent corridor (71 %). Horizontal types were less frequent with a relative incidence between 2 and 14 %.

Discussion

This study should increase the awareness for sacral dysmorphism, emphasize the importance of a preoperative assessment of the osseous corridor, and provide a simple method for the preoperative assessment with widely available tools.

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Title: A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation
Authors: Michael Goetzen
Kevin Ortner
Richard A. Lindtner
Rene Schmid
Michael Blauth
Dietmar Krappinger
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2528-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation

Abstract

Background

Materials and methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Discussion

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