Percutaneous placement of iliosacral screws without electrodiagnostic monitoring.
BACKGROUND
Iliosacral screws are commonly used for fixation of pelvic ring injuries. Previous reports using different screw insertion techniques have reported high neurologic complication rates, leading to recommendations for intraoperative neurodiagnostic monitoring. The purpose of this study was to evaluate the neurologic complications after percutaneous iliosacral screw placement without neurodiagnostic monitoring.


METHODS
During a 21-month period, 326 patients with pelvic ring disruptions were treated at a level 1 trauma center. One hundred seventy-four patients underwent percutaneous stabilization of their pelvic ring injuries without neurodiagnostic monitoring. Patients who were not intubated preoperatively, were neurologically normal, and who underwent a closed reduction were included. Sixty-eight patients who had 106 screws placed met the inclusion criteria and formed the study group. A careful and detailed neurologic examination was performed preoperatively and postoperatively. Plain pelvic radiographs and computed tomography scans were evaluated postoperatively in all patients to assess screw position.


RESULTS
No planned screw placement was abandoned because of inadequate fluoroscopic visualization. There were no neurologic injuries as a result of either the closed reduction or the screw placement. Computed tomography scans confirmed the screw position and demonstrated placement as intraosseous in 75 (70.8%) and juxtaforaminal in 31 (29.2%). No screws perforated a nerve root tunnel, spinal canal, or sacral cortex.


CONCLUSIONS
Using a standardized technique, appropriate and reliable fluoroscopic landmarks are available in the vast majority of percutaneous iliosacral screw fixation procedures. Iliosacral screw placement without neurodiagnostic monitoring has a low rate of neurologic complications.
Gardner
Michael J
MJ
Department of Orthopaedic Surgery, Harborview Medical Center, Washington 98104, USA. michaelgardnermd@gmail.com
Farrell
Eric D
ED
Nork
Sean E
SE
Segina
Daniel N
DN
Routt
M L Chip
ML
D001863:Bone Screws; D015331:Cohort Studies; D004568:Electrodiagnosis / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000293:injuries / Q000601:surgery; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008991:Monitoring, Physiologic / Q000639:trends; D009460:Neurologic Examination; D010384:Pelvic Bones / Q000293:injuries*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D018570:Risk Assessment; D012447:Sacrum / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome