Transiliac exposure of the sacrum: a new surgical approach

Biopsy or surgical approach of the midsacrum is difficult from the anterior, posterior, or superior approaches. I describe a lateral approach removing a piece of posterior ilium and entering the midsacrum through the sacroiliac joint. The approach was successfully used in an 8-year 7-month-old girl for the removal of an osteoid osteoma. The patient was monitored for 9 years 6 months until skeletally mature (age 18 years 1 month). This approach is applicable for biopsy or removal of benign tumors in the midsacrum in adults. Some developmental asymmetry of the pelvis may develop if it is used in children.