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Software-assisted preoperative planning of S1 Alar Iliac screws: a 3D morphometric and anatomical study

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Abstract

Purpose

S1 alar iliac (S1AI) trajectory has gained popularity as a salvage technique for revision surgeries and failed constructs in the lumbopelvic region. This study aims to investigate the morphometry of this new trajectory based on 3D models. The possible role of gender, ethnicity and view angle (surgeon’s vs. radiologist’s) was investigated.

Methods

Computed tomography-driven virtual 3D models of spinopelvic region were created applying Materialize MIMICS software, and assessed for coronal and sagittal radiographic versus surgeon’s view angles, and morphometry of the screw trajectory. Independent-samples t test was used to analyze the results. P value was set at <  = 0.05. The Statistical Package for the Social Sciences Software (SPSS version 24.0) was used for the statistical analysis.

Results

A total of 164 3D models were simulated with a total 328 screws inserted satisfactorily within the S1AI trajectory. S1AI instrumentation was feasible in 96.48%. The mean radiological coronal angle was 50.619' ± 8.590' and the mean coronal angle for surgeons’ perspective was 10.263' ± 5.860'. The mean radiological and surgeon’s perspective sagittal angles were found to be 44.532' ± 6.424' and 31.164' ± 5.455', respectively. A statistically significant difference was found between anatomical and surgeon’s perspective trajectories. Neither the pelvic laterality nor the gender influence the screw angles, length and diameter in radiological versus surgeon’s view angles.

Conclusion

Preoperative 3D modeling would be an invaluable adjunct to increase the accuracy of S1AI screw placement. Surgeon’s perspective of the trajectory differs from standard CT sections and should be considered in preoperative planning.

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Acknowledgements

This study was partially founded by the “Vice Chancellor of Research of Islamic Azad University of Medical Sciences.”

Funding

The authors declare that they have no financial interests.

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Authors and Affiliations

  1. Department of Neurosurgery, Tehran Medical Branch, Farhikhtegan Hospital, Islamic Azad University, Tehran, Iran

    Payman Vahedi

  2. Tehran Medical Branch, Bou-Ali Research Center, Islamic Azad University, Tehran, Iran

    Payman Vahedi, Ghazal Shabakhsh & Faeze Monji

  3. Department of Neurosurgery, Tehran Medical Branch, Bou-Ali Hospital, Islamic Azad University, Tehran, Iran

    Payman Vahedi & Ghazal Shabakhsh

Authors
  1. Payman Vahedi
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  2. Ghazal Shabakhsh
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  3. Faeze Monji
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Correspondence to Payman Vahedi.

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The authors declare no conflict of interest.

Ethical approval

Approval was obtained from the ethics committee of Islamic Azad University of Medical Sciences (IR.IAU.PS.REC1399.066). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Vahedi, P., Shabakhsh, G. & Monji, F. Software-assisted preoperative planning of S1 Alar Iliac screws: a 3D morphometric and anatomical study. Eur Spine J 32, 2274–2281 (2023). https://doi.org/10.1007/s00586-023-07741-1

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  • DOI: https://doi.org/10.1007/s00586-023-07741-1

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