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Intraoperative CT and Surgical Navigation for Iliosacral Screws: Technique for Patients with Sacral Dysmorphism

February 10, 2018

Contributors: Eddie Hasty, MD; Jannat M Khan, BS; Holly Tyler-Paris Pilson, MD; Samuel Rosas, MD; Alejandro Marquez-Lara, MD; Alejandro Marquez-Lara, MD

Percutaneous Iliosacral (IS) screw placement is technically challenging. While numerous intraoperative imaging technique have been developed to improve the safety and reliability of this procedure, sacral screw perforation and associated nerve injuries continue to be reported. Variability in patient anatomy, bone quality, and surgeon experience all contribute to the technical difficulty IS screw placement. The advent of intraoperative computer tomographic (CT) imaging allows the surgeon to map out the trajectory of the bony canal in a three-dimensional environment, therefore improving accuracy and safety. The presented video demonstrates the technique for percutaneous IS screw placement for a pelvic ring injury under intraoperative CT imaging guidance. Operative room setup, imaging acquisition, and technical pearls are highlighted. The author's preferred images for guidance are discussed as well as their utilization for start site localization, and safe pin and screw placement through the bony corridors in multiple planes.

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