Safe Corridor for Sacroiliac Screw Insertion Can Be Found Quickly Without the Use of the Lateral Sacral View.

Background: Studies have proved that in addition to the inlet and outlet views, the intraoperative lateral sacral view is required to ensure the correct entry point, reduce operating time, and lower radiation exposure. Considering the complex anatomy of the sacrum, we showed a safe corridor for sacroiliac joint (SIJ) screw insertion that was accessible using only inlet and outlet fluoroscopic views.
Methods: From 2013 to 2020, we enrolled 215 patients who underwent percutaneous SIJ screw insertion. Our experience in SIJ screw insertion is presented using only two views (inlet and outlet). We reported on the radiation exposure time, operating time, rate of screw malposition, neurologic injury, and revision surgery.
Results: The screw malposition rate was 5.5%, including 11 foraminal perforations and one perforated anterior sacral cortex. Paresthesia after the surgery was observed in six patients (2.8%). No revision surgery or screw removal was performed. The radiation exposure and operation time for each screw were 21 ± 4.5 s and 13.5 min, respectively.
Conclusion: The most anterior and the lowest part of the S1 vertebra can be easily found using intraoperative inlet and outlet views. It is a safe corridor for SIJ screw insertion with low radiation time, neurologic injury, and revision rates.