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. 2014 Dec 1:8:3.
doi: 10.14444/1003. eCollection 2014.

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

Jared Fridley  1 , Daniel Fahim  2 , Jovany Navarro  1 , J P Wolinsky  3 , Ibrahim Omeis  1
Affiliations

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

Jared Fridley et al. Int J Spine Surg. .

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.

Keywords: Deformity; Iliac screws; lumbosacral; spinopelvic fixation.

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Figures

Fig. 1
Fig. 1
Illustration of the free-hand technique for iliac screw placement. Note that the probe shafts are parallel to the L5 lamina with both probes intersecting over the L5 spinous process. The screw entry point is adjacent to the PSIS.
Fig. 2
Fig. 2
Intraoperative photograph demonstrating the trajectory of both pedicle probes.
Fig. 3
Fig. 3
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.
See this image and copyright information in PMC

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