HYBRID EVENT: You can participate in person at Orlando, USA or Virtually from your home or work.

6th Edition of International Conference on Neurology and Brain Disorders

October 24 -26, 2022

October 24 -26, 2022 | Orlando, Florida, USA
INBC 2022

Sajjad Saghebdoust

Speaker at Neurology and Brain Disorders 2022 - Sajjad Saghebdoust
Tehran University of Medical Sciences, Iran (Islamic Republic of)
Title : Percutaneous Iliosacral Screw Insertion with only Outlet and Inlet Fluoroscopic View for Unstable Pelvic Ring Injuries: Clinical and Radiological Outcomes

Abstract:

Introduction: Percutaneous iliosacral screw fixation in posterior pelvic ring fractures is a challenging operation and commonly performs under fluoroscopy or navigation techniques. The purpose of this study was to assess the safety and efficacy of percutaneous iliosacral screw implantation under fluoroscopy guidance with only inlet and outlet views.

Methods: This retrospective study included 58 consecutive unstable posterior pelvic injury patients (36 sacral fractures, 22 sacroiliac joint disruptions) treated with percutaneous iliosacral screws between January 2015 and November 2019. A single surgeon operated on all patients; Acceptable inlet radiographs show the anterior cortex of the S1 body superimposed on the S2 body. Acceptable outlet radiographs show the superior pubic symphysis at the level of S2 foramen and visualizes the S1 and S2 sacral foramens. In our technique, the screw was inserted at the inferior half of the outlet view and the posterior half of the inlet view. The time needed for screw insertion and the radiation exposure time was recorded. Intra and post-operative complications documented. Post-operative CT scans assessed screw position.

Results: In total, 69 iliosacral screws were inserted in 58 patients. In post-operative CT scans, the screw position was assessed, and 89.8% were in a secure position, and 10.2% had malposition. The mean operation time per screw was 21.18 minutes and the mean fluoroscopy time per screw was 112 seconds. There was no evidence of wound infection or iatrogenic neurovascular injury. No reoperation was performed.

Conclusions: Percutaneous iliosacral screws can be placed using only outlet and inlet fluoroscopic views with comparable radiological and clinical outcomes to the conventional method.

What will audience learn from your presentation?

  • Percutaneous iliosacral screw placement is a challenging and technically demanding surgery, mostly due to highly varied pelvic anatomy and screw trajectories. Moreover, on account of complex osseous anatomy, obesity, and bowel gas, the iliosacral screw position assessment can be challenging.
  • In our study, the rate of iliosacral screw malposition using the conventional method was 10.2%, with a comparable success rate reported previously in the literature.
  • Correct inlet and outlet views using the intraoperative C-arm necessitate various angles because of variations in the sacral bone anatomy. Identifying the necessary inlet and outlet view angle can reduce operative time and intraoperative irradiation.
  • In our study, the inlet view was acceptable when radiographs show the anterior cortex of the S1 body superimposed on the S2 body and double-cortical density of the overlaid vertebral bodies is visualized. Outlet view was acceptable when radiographs showed the superior pubic symphysis at the level of S2 foramen and visualization of S1 and S2 sacral foramen. If on the outlet view, the trajectory of the screw is superior to the S1 foramen, and within the alar confines on the inlet view, violation of the anterior or posterior neurovascular structures is implausible. To avoid partial cut-out risk, we placed the screw at the inferior half on the outlet view and the posterior half on the inlet view.
  • Our study measured a fluoroscopic time of 108 ± 12 seconds per screw and an operating time of 21.18 minutes. The possibility for lesser radiation exposure to the patient and surgical team and a quicker operating time compared to previous studies are two advantages of our fluoroscopic technology.

 

Biography:

Dr. Sajjad Saghebdoust studied medicine at Mashhad University of Medical Sciences and attained 8th place in the national pre-internship examination, thereby becoming a member of Iran's National Elites Foundation. He graduated as MD in 2021 and obtained MBA and MPH degrees thereafter. Meanwhile, he was awarded two neurosurgery research positions in two well-known neurosurgical centers, the Neurosurgery Department of Razavi Hospital (Mashhad, Iran) and the Sports Medicine Research Center at Tehran University of Medical Sciences. Since then, he has been involved in a wealth of cutting-edge neurosurgical research projects under the supervision of several distinguished neurosurgeons.

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