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Free-hand placement of iliac screws for spinopelvic fixation based on anatomical landmarks: technical note.

Fridley J, Fahim D, Navarro J, Wolinsky JP, Omeis I - Int J Spine Surg (2014)

Bottom Line: We have successfully used this technique for the placement 20 iliac screws based on anatomic landmarks in 10 consecutive patients.Based on our limited experience to date, free-hand placement of iliac screws is both easy to perform and safe for the patient.Further study and validation using this technique is warranted.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX.

ABSTRACT

Background: The placement of iliac screws is a biomechanically sound method for the stabilization of long multi-segment lumbar constructs. Traditional techniques for the placement of iliac screws often involve either substantial iliac muscle dissection for visualization of screw trajectory based on bony landmarks, or alternatively the use of intra-operative imaging to visualize these landmarks and guide screw placement. We describe an alternative free-hand method of iliac screw placement, one that needs neither significant muscle dissection nor intra-operative imaging.

Methods: We performed this technique in 10 consecutive patients. Patient demographics, spinal pathology, post-operative complications, and screw hardware characteristics are described.

Results: We have successfully used this technique for the placement 20 iliac screws based on anatomic landmarks in 10 consecutive patients. There were no cortical breeches of the ileum and no penetrations into the acetabulum on post-operative imaging. There were no instances of hardware failure. Two patients developed deep vein thromboses after surgery, 1 had a pulmonary embolism.

Conclusions: Based on our limited experience to date, free-hand placement of iliac screws is both easy to perform and safe for the patient. Further study and validation using this technique is warranted.

No MeSH data available.


Related in: MedlinePlus

a) Post-operative CT scan of lumbosacral spine, axial view, demonstrating the trajectory of the iliac screws placed through the ilium. b) anterior-posterior post-operative x-ray illustrating a spinopelvic fixation construct.
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Figure 0003: a) Post-operative CT scan of lumbosacral spine, axial view, demonstrating the trajectory of the iliac screws placed through the ilium. b) anterior-posterior post-operative x-ray illustrating a spinopelvic fixation construct.

Mentions: A total of 20 screws were placed over a one year period in 10 patients using this free-hand technique. (Table 1) The sciatic notch was not dissected or exposed, nor was fluoroscopy used, for the placement of iliac screws in any of these cases. There were no intra-operative complications and no post-operative complications related to iliac screw placement. We evaluated the accuracy of our screw placement by measuring the shortest distance between the screw and the sciatic notch as well as the shortest distance to the AIIS. There were no cortical breeches of the ileum and no penetrations into the acetabulum in any of the cases. On post-operative CT scans the distances of the iliac screws above the sciatic notch ranged from 13 to 22 mm. Screw lengths of 90-110 mm were utilized with a screw diameter of 8.5 to 9.5mm. Patients were seen in follow up, on average, out to 28 months after surgery (range 24 to 40 months). There were no instances of hardware failure. Two patients developed deep vein thromboses after surgery, and an additional patient developed a pulmonary embolism. An illustrative case after screw placement using post-operative CT is provided (Figure 3).


Free-hand placement of iliac screws for spinopelvic fixation based on anatomical landmarks: technical note.

Fridley J, Fahim D, Navarro J, Wolinsky JP, Omeis I - Int J Spine Surg (2014)

a) Post-operative CT scan of lumbosacral spine, axial view, demonstrating the trajectory of the iliac screws placed through the ilium. b) anterior-posterior post-operative x-ray illustrating a spinopelvic fixation construct.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325501&req=5

Figure 0003: a) Post-operative CT scan of lumbosacral spine, axial view, demonstrating the trajectory of the iliac screws placed through the ilium. b) anterior-posterior post-operative x-ray illustrating a spinopelvic fixation construct.
Mentions: A total of 20 screws were placed over a one year period in 10 patients using this free-hand technique. (Table 1) The sciatic notch was not dissected or exposed, nor was fluoroscopy used, for the placement of iliac screws in any of these cases. There were no intra-operative complications and no post-operative complications related to iliac screw placement. We evaluated the accuracy of our screw placement by measuring the shortest distance between the screw and the sciatic notch as well as the shortest distance to the AIIS. There were no cortical breeches of the ileum and no penetrations into the acetabulum in any of the cases. On post-operative CT scans the distances of the iliac screws above the sciatic notch ranged from 13 to 22 mm. Screw lengths of 90-110 mm were utilized with a screw diameter of 8.5 to 9.5mm. Patients were seen in follow up, on average, out to 28 months after surgery (range 24 to 40 months). There were no instances of hardware failure. Two patients developed deep vein thromboses after surgery, and an additional patient developed a pulmonary embolism. An illustrative case after screw placement using post-operative CT is provided (Figure 3).

Bottom Line: We have successfully used this technique for the placement 20 iliac screws based on anatomic landmarks in 10 consecutive patients.Based on our limited experience to date, free-hand placement of iliac screws is both easy to perform and safe for the patient.Further study and validation using this technique is warranted.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX.

ABSTRACT

Background: The placement of iliac screws is a biomechanically sound method for the stabilization of long multi-segment lumbar constructs. Traditional techniques for the placement of iliac screws often involve either substantial iliac muscle dissection for visualization of screw trajectory based on bony landmarks, or alternatively the use of intra-operative imaging to visualize these landmarks and guide screw placement. We describe an alternative free-hand method of iliac screw placement, one that needs neither significant muscle dissection nor intra-operative imaging.

Methods: We performed this technique in 10 consecutive patients. Patient demographics, spinal pathology, post-operative complications, and screw hardware characteristics are described.

Results: We have successfully used this technique for the placement 20 iliac screws based on anatomic landmarks in 10 consecutive patients. There were no cortical breeches of the ileum and no penetrations into the acetabulum on post-operative imaging. There were no instances of hardware failure. Two patients developed deep vein thromboses after surgery, 1 had a pulmonary embolism.

Conclusions: Based on our limited experience to date, free-hand placement of iliac screws is both easy to perform and safe for the patient. Further study and validation using this technique is warranted.

No MeSH data available.


Related in: MedlinePlus