Safe Corridor for Sacroiliac Screw Insertion Can Be Found Quickly Without the Use of the Lateral Sacral View

Background:Studies have proved that in addition to the inlet and outlet views, the intraoperative lateral sacral viewis required to ensure the correct entry point, reduce operating time, and lower radiation exposure. Considering thecomplex anatomy of the sacrum, we showed a safe corridor for sacroiliac joint (SIJ) screw insertion that was accessibleusing only inlet and outlet fluoroscopic views.Methods: From ۲۰۱۳ to ۲۰۲۰, we enrolled ۲۱۵ patients who underwent percutaneous SIJ screw insertion. Ourexperience in SIJ screw insertion is presented using only two views (inlet and outlet). We reported on the radiationexposure time, operating time, rate of screw malposition, neurologic injury, and revision surgery.Results: The screw malposition rate was ۵.۵%, including ۱۱ foraminal perforations and one perforated anterior sacralcortex. Paresthesia after the surgery was observed in six patients (۲.۸%). No revision surgery or screw removal wasperformed. The radiation exposure and operation time for each screw were ۲۱ ± ۴.۵ s and ۱۳.۵ min, respectively.Conclusion: The most anterior and the lowest part of the S۱ vertebra can be easily found using intraoperative inletand outlet views. It is a safe corridor for SIJ screw insertion with low radiation time, neurologic injury, and revision rates.Level of evidence: IV

Keywords:

lateral sacral view , percutaneous fixation , posterior pelvic ring injury , sacroiliac joint screw