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Anatomical considerations for percutaneous trans ilio-sacroiliac S1 and S2 screw placement

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Abstract

Objective

To determine the presence of a consistent osseous corridor through S1 and S2 and fluoroscopic landmarks thereof, which could be used for safe trans ilio-sacroiliac screw fixation of posterior pelvic ring disorders.

Study design

Computed tomography (CT) based anatomical investigation utilising multiplanar image and trajectory reconstruction (Agfa-IMPAX Version 5.2 software). Determination of the presence and dimension of a continuous osseous corridor in the coronal plane of the sacrum at the S1 and S2 vertebral levels.

Outcome measures

Determination of: (a) the presence of an osseous corridor in the coronal plane through S1 and S2 in males and females; (b) the dimension of the corridor with regard to diameter and length; (c) the fluoroscopic landmarks of the corridor.

Results

The mean cross-sectional area for S1 corridors in males and females was 2.13 and 1.47 cm2 , respectively. The mean cross-sectional area for the S2 corridor in males and females was 1.46 and 1.13 cm2, respectively. The limiting anatomical factor is the sagittal diameter of the sacral ala at the junction to the vertebral body. The centre of the S1 and S2 corridor is located in close proximity to the centre of the S1 and S2 vertebrae on the lateral fluoroscopic view as determined by the adjacent endplates and anterior and posterior vertebral cortices.

Conclusion

Two-thirds of males and females have a complete osseous corridor to pass a trans-sacroiliac S1 screw of 8 mm diameter. The S2 corridor was present in all males but only in 87 % of females. Preoperative review of the axial CT slices at the midpoint of the S1 or S2 vertebral body allows the presence of a trans-sacroiliac osseous corridor to be determined by assessing the passage at the narrowest point of the corridor at the junction of the sacral ala to the vertebral body.

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References

  1. Roy-Camille R, Saillant G, Gagna G, Mazel C (1985) Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine (Phila Pa 1976) 10:838–845

    Article  CAS  Google Scholar 

  2. Gibbons KJ, Soloniuk DS, Razack N (1990) Neurological injury and patterns of sacral fractures. J Neurosurg 72:889–893. doi:10.3171/jns.1990.72.6.0889

    Article  CAS  PubMed  Google Scholar 

  3. Bellabarba C, Schildhauer TA, Vaccaro AR, Chapman JR (2006) Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976) 31:S80–S88. doi:10.1097/01.brs.0000217949.31762.be (discussion S104)

    Article  Google Scholar 

  4. Mouhsine E, Wettstein M, Schizas C et al (2006) Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J 15:857–863. doi:10.1007/s00586-004-0858-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Schildhauer TA, Bellabarba C, Nork SE et al (2006) Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma 20:447–457

    Article  PubMed  Google Scholar 

  6. König MA, Jehan S, Boszczyk AA, Boszczyk BM (2012) Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J 21:829–836. doi:10.1007/s00586-011-2125-7

    Article  PubMed  PubMed Central  Google Scholar 

  7. Matta JM, Tornetta P (1996) Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 329:129–140

    Article  PubMed  Google Scholar 

  8. Gänsslen A, Hüfner T, Krettek C (2006) Die bildwandergestützte, perkutane transiliosakrale Schrauben-fixation instabiler Beckenverletzungen. Oper Orthop Traumatol 18:225–244. doi:10.1007/s00064-006-1173-3

    Article  PubMed  Google Scholar 

  9. Osterhoff G, Ossendorf C, Wanner GA et al (2011) Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury 42:992–996. doi:10.1016/j.injury.2011.04.005

    Article  PubMed  Google Scholar 

  10. Routt M Jr (2006) Posterior pelvic-ring disruptions: iliosacral screws. In: Wiss D (ed) Fractures. Lippincott, Williams & Wilkins, Philadelphia, pp 649–667

    Google Scholar 

  11. Nork SE, Jones CB, Harding SP et al (2001) Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma 15:238–246. doi:10.1097/00005131-200105000-00002

    Article  CAS  PubMed  Google Scholar 

  12. Mendel T, Appelt K, Kuhn P, Suhm N (2008) Bony sacroiliac corridor. A virtual volume model for the accurate insertion of transarticular screws. Unfallchirurg 111:19–26. doi:10.1007/s00113-007-1386-4

    Article  CAS  PubMed  Google Scholar 

  13. Noojin FK, Malkani AL, Haikal L et al (2000) Cross-sectional geometry of the sacral ala for safe insertion of iliosacral lag screws: a computed tomography model. J Orthop Trauma 14:31–35

    Article  CAS  PubMed  Google Scholar 

  14. Day CS, Prayson MJ, Shuler TE et al (2000) Transsacral versus modified pelvic landmarks for percutaneous iliosacral screw placement—a computed tomographic analysis and cadaveric study. Am J Orthop (Belle Mead NJ) 29:16–21

    CAS  Google Scholar 

  15. Karachalios T, Zibis AH, Zintzaras E et al (2010) An anatomical update on the morphologic variations of S1 and S2. Orthopedics 33:733. doi:10.3928/01477447-20100826-12

    PubMed  Google Scholar 

  16. Vanderschot P, Meuleman C, Lefevre A, Broos P (2001) Trans iliac–sacral–iliac bar stabilisation to treat bilateral lesions of the sacro–iliac joint or sacrum: anatomical considerations and clinical experience. Injury 32:587–592

    Article  CAS  PubMed  Google Scholar 

  17. König M, Seidel U, Heini P (2013) Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures. J Spinal Disord Tech 00:1–7

    Google Scholar 

  18. Gardner MJ, Routt MLC (2011) Transiliac-transsacral screws for posterior pelvic stabilization. J Orthop Trauma 25:378–384. doi:10.1097/BOT.0b013e3181e47fad

    Article  PubMed  Google Scholar 

  19. Carlson DA, Scheid DK, Maar DC et al (2000) Safe placement of S1 and S2 iliosacral screws: the “vestibule” concept. J Orthop Trauma 14:264–269

    Article  CAS  PubMed  Google Scholar 

  20. Schildhauer TA, Bellabarba C, Nork SE et al (2006) Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma 20:447–457. doi:10.1097/00005131-200608000-00001

    Article  PubMed  Google Scholar 

  21. Fensky F, Schäffler A, Siebenlist S et al (2011) Percutaneous iliosacral screw fixation for pelvis insufficiency fracture after implantation of a pedestal cup: case report. Unfallchirurg 114:1115–1119. doi:10.1007/s00113-010-1908-3

    Article  CAS  PubMed  Google Scholar 

  22. Bale RJ, Kovacs P, Dolati B et al (2008) Stereotactic CT-guided percutaneous stabilization of posterior pelvic ring fractures: a preclinical cadaver study. J Vasc Interv Radiol 19:1093–1098. doi:10.1016/j.jvir.2008.04.006

    Article  PubMed  Google Scholar 

  23. Sciulli RL, Daffner RH, Altman DT et al (2007) CT-guided iliosacral screw placement: technique and clinical experience. AJR Am J Roentgenol 188:181–192. doi:10.2214/AJR.05.0479

    Article  Google Scholar 

  24. Vanderschot P, Kuppers M, Sermon A, Lateur L (2009) Trans-iliac-sacral-iliac-bar procedure to treat insufficiency fractures of the sacrum. Indian J Orthop 43:245–252. doi:10.4103/0019-5413.53454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Papanastassiou ID, Setzer M, Eleraky M et al (2011) Minimally invasive sacroiliac fixation in oncologic patients with sacral insufficiency fractures using a fluoroscopy-based navigation system. J Spinal Disord Tech 24:76–82. doi:10.1097/BSD.0b013e3181df8e6b

    Article  PubMed  Google Scholar 

  26. Kaiser SP, Gardner MJ, Liu J et al (2014) Anatomic determinants of sacral dysmorphism and implications for safe iliosacral screw placement. J Bone Joint Surg Am 96:e120. doi:10.2106/JBJS.M.00895

    Article  PubMed  Google Scholar 

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Acknowledgments

The author would like to thank Spinegraphics Nottingham for the illustrations in this manuscript.

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Authors and Affiliations

  1. The Centre for Spinal Studies and Surgery, Queens Medical Centre Campus, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK

    M. A. König, R. O. Sundaram, P. Saville, S. Jehan & Bronek M. Boszczyk

Authors
  1. M. A. König
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  2. R. O. Sundaram
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  3. P. Saville
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  4. S. Jehan
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  5. Bronek M. Boszczyk
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Correspondence to M. A. König.

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No benefits or funds in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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König, M.A., Sundaram, R.O., Saville, P. et al. Anatomical considerations for percutaneous trans ilio-sacroiliac S1 and S2 screw placement. Eur Spine J 25, 1800–1805 (2016). https://doi.org/10.1007/s00586-015-4327-x

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  • DOI: https://doi.org/10.1007/s00586-015-4327-x

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