title: Minimally Invasive Percutaneous Iliac Screws: Initial 24 Case Experiences With CT Confirmation.
abstract: Percutaneous pedicle screws have become accepted as an effective method for segmental fixation in a variety of settings. However, fixation to the pelvis, which offers unique biomechanical advantages, had remained elusive from a minimally invasive approach.
  
  
  
  To ascertain the safety of percutaneous iliac screws implanted placement using fluoroscopic guidance.
  
  
  
  In an effort to verify the accuracy of a fluoroscopically guided technique for safe iliosacral screw placement, we reviewed the imaging results from 24 consecutive patients undergoing this procedure. Percutaneous iliac screw placement was accomplished using primarily x-ray-guided screw insertion (obturator outlet view technique) without frameless image-guidance and with limited exposure of bony landmarks or tactile feedback. Indications for surgery included infection, neoplasia, trauma, and deformity. All patients underwent early postoperative computed tomography scanning to determine the accuracy of screw positioning.
  
  
  
  A total of 24 patients had 47 screws placed for fixation at the lumbosacral junction. No cases required abortion of the procedure or conversion to an open operation. All of the percutaneous screws were placed appropriately as verified by postoperative computed tomography scanning with 3-dimensional reconstruction. There were no hardware-related complications. However, one 75-year-old patient suffering a sacral fracture died of medical comorbidities on postoperative day 10.
  
  
  
  A minimally invasive technique for iliac screw placement can be performed safely with a low likelihood of bony violation. This technique offers the unique biomechanical advantages of iliac fixation without the soft-tissue exposure traditionally needed for safe hardware insertion. The technique relies on high-quality intraoperative fluoroscopic imaging.
authors.affiliation: *Departments of Neurological Surgery & Rehabilitation Medicine, University of Miami Miller School of Medicine, Lois Pope LIFE Center†Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, FL‡Department of Neurological Surgery, University of California, San Francisco, CA§Carolina Spine and Neurosurgery Center, Asheville, NC.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
authors.forename: Seth
authors.initials: S
authors.lastname: Williams
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome