Skip to main content

Advertisement

SpringerLink
Log in

The sacral screw placement depending on morphological and anatomical peculiarities

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Various pathologies of the lumbosacral junction require fusion of the L5/S1 segment. However, pseudarthroses, which often come along with sacral screw loosening, are problematic. The aim of the present investigation was to elaborate the morphological features of the L5/S1 segment to define a so-called “safe zone” for bi- or tricortical screw placement without risking a damage of the iliac vessels.

Methods

A total of one hundred computed tomographies of the pelvis were included in this investigation. On axial and sagittal slices, pedicle morphologies, the prevertebral position of the iliac vessels, the spinal canal and the area with the largest bone density were analyzed.

Results

Beginning from the entry point of S1-srews iliac vessels were located at an average angle of 7° convergence, the spinal canal at 38°. Bone density was significantly higher centrally with a mean value of 276 Hounsfield Units compared to the area of the Ala ossis sacri. The largest intraosseous screw length could be achieved at an angle of 25°. The average pedicle width was 20 mm and the pedicle height 13 mm.

Conclusions

A “safe-zone” for bicortical screw placement at S1 with regard to the course of the iliac vessels could be defined between 7° and 38° convergence. Regarding the area offering the largest bone density and the maximal possible screw length, a convergence of 25° is recommended at S1 to reduce the incidence of screw loosening. Screw diameter, as a further influence factor on screw holding, is limited by pedicle height not pedicle width.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Asher MA, Strippgen WE (1986) Anthropometric studies oft he human sacrum relating to dorsal transsacral implant designs. Clin Orthop 203:58

    Google Scholar 

  2. Cho W, Cho SK, Wu C (2010) The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg Br 92-B:1061–1065

    Article  Google Scholar 

  3. Cook S (2004) Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J 4:402–408

    Article  Google Scholar 

  4. Cook SD, Barbera J, Rubi M, Salkeld SL, Whitecloud TS (2001) Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation ans osteoporosis. Spine J 1:109–114

    Article  CAS  Google Scholar 

  5. De Peretti F, Argenson C, Bourgeon A, Omar F, Eude P, Aboulker C (1991) Anatomic and experimental basis fort he insertion of a screw at the first sacral vertebra. Surg Radiol Anat 13:133–137

    Article  Google Scholar 

  6. Gstöttner M, Glodny B, Petersen J, Thaler M, Bach CM (2011) CT Angiography for anterior lumbar spine access. High radiation exposure and low clinical relevance. Clin Orthop Relat Res 469:819–824

    Article  Google Scholar 

  7. Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T et al (1997) Structural characteristics of the pedicle and its role in screw stability. Spine 22:2504–2510

    Article  CAS  Google Scholar 

  8. Kaptanoglu E, Okutan O, Tekdemir I, Beskonakli E, Deda H (2003) Closed posterior superior iliac spine impeding pediculocorporeal S1 screw insertion. J Neurosurg 99:229–234

    PubMed  Google Scholar 

  9. Krag MH, Weaver DL, Beynnon BD, Haugh LD (1988) Morphometry oft he thoracic and lumbar spine related to transpedicular screw placement for surgical spine fixation. Spine 13:27–32

    Article  CAS  Google Scholar 

  10. Lehman RA, Kuklo TR, Belmont PJ, Andersen RC, Polly DW (2002) Advantage of pedicle screw fixation directed into the apex the sacral promontory over bicortical fixation: a biomechanical analysis. Spine 15:806–811

    Article  Google Scholar 

  11. Lei W, Wu Z (2006) Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J 15:321–326

    Article  Google Scholar 

  12. Lien SB, Lien SB, Liou NH, Wu SS (2007) Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16:1215–1222

    Article  Google Scholar 

  13. McCord DH, Cunningham BW, Shono Y, Myers JJ, AcAfee PC (1992) Biomechanical analysis of lumbosacral fixation. Spine 17:235–243

    Article  Google Scholar 

  14. Pickhardt PJ, Poller BD, Lauder T, Munos del Rio A, Bruce RJ, Binkley N (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Int Med 158:588–595

    Article  Google Scholar 

  15. Robertson PA, Stewart NR (2000) The radiologic anatomy oft he lumbar and lumbosacral pedicles. Spine 25:709–715

    Article  CAS  Google Scholar 

  16. Sansur CA, Caffes NM, Ibrahimi DM, Pratt NL, Lewis EM, Murgatroyd AA, Cunningham BW (2016) Biomechanical fixation properties of cortical versus transpedicular screws in the osteoporotic lumbar spine: an in vitro human cadaveric model. Am Assoc Neurol Surg 25:1–10

    Google Scholar 

  17. Shea TM, Laun J, Gonzales-Blohm SA, Doulgeris JJ, Lee WE, Aghayev K, Vrionis FD (2014) Designs and techniques that improve the pullout strength of pedicle screws in osteoporotic vertebrae: current Status. Biomed Res Int. https://doi.org/10.1155/2014/748393

    Article  PubMed  PubMed Central  Google Scholar 

  18. Voboril R (2001) Location oft he aortic bifurcation in man and its practical significance in vascular surgery. Zentralbl Chir 126:93–96

    Article  CAS  Google Scholar 

  19. Weiser L, Huber G, Sellenschloh K, Viezens L, Püschel K, Morlock MM, Lehmann W (2017) Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength. Eur Spine J 26:2891–2897

    Article  Google Scholar 

  20. Wittenberg RH, Lee KS, Shea HM, White AA, Hayes WC (1993) Effect of screw diameter, insertion technique and bone cement augmentation of pedicular screw fixation stregth. Clin Orthop Relat Res 296:278–287

    Google Scholar 

  21. Xu R, Ebraheim NA, Gove NK (2008) Surgical anatomy of the sacrum. Am J Orthop 37:E177–E181

    PubMed  Google Scholar 

  22. Yoshii T, Hirai T, Yamada T, Sumiya S, Mastumoto R, Kato T et al (2015) Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis view and cannulated tapping device. J Orthop Surg Res 10:79–85

    Article  Google Scholar 

  23. Zhu Q, Lu WW, Holmes AD, Zheng Y, Zhong S, Leong JC (2000) The effects of cyclic loading on pull-out strength of sacral screw fixation: an in vitro biomechanical study. Spine 25:1065–1069

    Article  CAS  Google Scholar 

  24. Zindrick MR, Wiltse LL, Widell EH, Thomas JC, Holland WR, Field WT, Spencer CW (1986) A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 203:99–112

    Google Scholar 

Download references

Funding

No funding was achieved.

Author information

Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Hospital of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Carolin Meyer, David Grevenstein, Jan Bredow, Peer Eysel & Max Joseph Scheyerer

  2. Department of Spine Surgery, Hospital Leverkusen, Leverkusen, Germany

    Peter Pfannebecker & Jan Siewe

Authors
  1. Carolin Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Pfannebecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Siewe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Grevenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Bredow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peer Eysel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Max Joseph Scheyerer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CM: Support and advise data collection, manuscript writing. PP: Performed data collection and analysis, manuscript editing. JS: Protocol development, manuscript editing. DG: Data analysis and management, manuscript editing. JB: Data management, manuscript editing. PE: Data analysis and management, manuscript editing. MJS: Project and protocol development, data analysis, manuscript editing.

Corresponding author

Correspondence to Carolin Meyer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meyer, C., Pfannebecker, P., Siewe, J. et al. The sacral screw placement depending on morphological and anatomical peculiarities. Surg Radiol Anat 42, 299–305 (2020). https://doi.org/10.1007/s00276-019-02373-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-019-02373-x

Keywords

Search

Navigation