title: Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular Surgery: An Anatomical Study.
abstract: BACKGROUND
  Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw.
  
  
  METHODS
  Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord.
  
  
  RESULTS
  The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant.
  
  
  CONCLUSIONS
  Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Firoozabadi
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Stafford
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA USA.
authors.forename: Milton
authors.initials: M
authors.lastname: Routt
keywords: Acetabular surgery; Ilioinguinal approach; Retrograde ramus screw; Spermatic cord; Stoppa