Universität zu Köln

Meyer, Carolin, Pfannebecker, Peter, Siewe, Jan, Grevenstein, David, Bredow, Jan, Eysel, Peer and Scheyerer, Max Joseph (2020). The sacral screw placement depending on morphological and anatomical peculiarities. Surg. Radiol. Anat., 42 (3). S. 299 - 306. PARIS: SPRINGER FRANCE. ISSN 1279-8517

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Abstract

Purpose Various pathologies of the lumbosacral junction require fusion of the L5/S1 segment. However, pseudarthroses, which often come along with sacral screw loosening, are problematic. The aim of the present investigation was to elaborate the morphological features of the L5/S1 segment to define a so-called safe zone for bi- or tricortical screw placement without risking a damage of the iliac vessels. Methods A total of one hundred computed tomographies of the pelvis were included in this investigation. On axial and sagittal slices, pedicle morphologies, the prevertebral position of the iliac vessels, the spinal canal and the area with the largest bone density were analyzed. Results Beginning from the entry point of S1-srews iliac vessels were located at an average angle of 7 degrees convergence, the spinal canal at 38 degrees. Bone density was significantly higher centrally with a mean value of 276 Hounsfield Units compared to the area of the Ala ossis sacri. The largest intraosseous screw length could be achieved at an angle of 25 degrees. The average pedicle width was 20 mm and the pedicle height 13 mm. Conclusions A safe-zone for bicortical screw placement at S1 with regard to the course of the iliac vessels could be defined between 7 degrees and 38 degrees convergence. Regarding the area offering the largest bone density and the maximal possible screw length, a convergence of 25 degrees is recommended at S1 to reduce the incidence of screw loosening. Screw diameter, as a further influence factor on screw holding, is limited by pedicle height not pedicle width.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Meyer, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfannebecker, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Siewe, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Grevenstein, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Bredow, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel, Peer UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheyerer, Max Joseph UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-127217
DOI:	10.1007/s00276-019-02373-x
Journal or Publication Title:	Surg. Radiol. Anat.
Volume:	42
Number:	3
Page Range:	S. 299 - 306
Date:	2020
Publisher:	SPRINGER FRANCE
Place of Publication:	PARIS
ISSN:	1279-8517
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PEDICLE SCREW; FIXATION; LUMBAR; MORPHOMETRY; INSERTION Multiple languages Anatomy & Morphology; Radiology, Nuclear Medicine & Medical Imaging; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12721