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KMID : 1040920220070010060
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Journal of Minimally Invasive Spine Surgery and Technique
2022 Volume.7 No. 1 p.60 ~ p.67
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Minimally Invasive Iliac Screw Insertion: Clinical Case Series and Technical Note
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Srikantha Umesh
Lokanath Yadhu K.
Hari Akshay
Somasundar Deepak
Varma Ravi Gopal
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Abstract
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Objective: To describe the technique of minimally invasive iliac screw insertion by freehand technique and using intraoperative navigation guidance.
Methods: Bilateral iliac screws were inserted in total of seven patients. Five patients under- went navigation guided iliac screw placement and freehand technique was performed in 2 patients.
Results: Total of 7 patients underwent minimally invasive iliac screw fixation in our series. The pathology in 4 of the cases was spondylodiscitis, among them 2 cases each at L5-S1 and L4-L5, one with the destruction of L5 vertebral body and the other with the destruction of both L4 and L5 vertebral bodies. Of the remaining cases, two cases , one case of sacral insufficiency fracture and the last case was implant failure after L2-L5 oblique lumbar fusion. None of the cases required conversion to open procedure or had wound or hardware related complications till the last follow-up. All patients had an uneventful post-operative period with improvement in pain scores and were mobilized on the 1st postoperative day. One 50-year-old female patient suffering from L5-S1 tubercular spondylodiscitis died due to underlying chronic kidney disease three months post-surgery.
Conclusion: Minimal invasive iliac screw placement with or without navigation offers the same biomechanical stability as the open approach but without the need for extensive soft tissue exposure needed for a conventional/open procedure; thereby reducing exposure-related complications , enhancing post-operative recovery and early mobilization. Incorporating intra-operative 3D navigation provides real-time multi-planar images which help in easy planning and safe screw placement whilst reducing radiation exposure.
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KEYWORD
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Iliac screws, Minimally invasive iliac screw, Percutaneous iliac screw, Navigation guided iliac screw, Lumbo-pelvic stabilization
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