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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 screw placement is technically challenging. Although numerous intraoperative imaging techniques have been developed to improve the safety and reliability of percutaneous iliosacral screw placement, sacral screw perforation and associated nerve injuries continue to be reported. Variability in patient anatomy, bone quality, and surgeon experience contribute to the technical difficulty of percutaneous iliosacral screw placement. The advent of intraoperative CT allows surgeons to map the trajectory of the bony canal in a three-dimensional environment, thereby improving accuracy and safety. This video demonstrates the technique for percutaneous iliosacral screw placement under intraoperative CT guidance in a patient with a pelvic ring injury. Operating room setup, imaging study acquisition, and technical pearls are highlighted. The author's preferred imaging studies for guidance and their utility for starting site localization and safe pin and screw placement through the bony corridors in multiple planes are discussed.