Computer-guidance in percutaneous screw stabilization of the iliosacral joint

Nine patients with instability and one patient with degeneration of the iliosacral joint were treated surgically. The posterior pelvic ring was stabilized with the assistance of an optoelectronic navigation system. Registration was ensured by using fiducial screws in the iliac crest or by collecting landmarks on the external fixator. Computed tomography scans taken postoperatively provided additional information regarding implant localization in all patients. Accurate placement of 21 of 22 implanted iliosacral screws was observed. Two of the 21 screws touched the wall of the second sacral foramen without perforating the canal. One screw perforated the anterior wall of the sacrum because the navigated guide wire was bent during implantation. The initial results indicate that computer-aided frameless navigation in surgery of the iliosacral joint can facilitate surgical performance during screw stabilization in selected patients. Two important issues must be considered in the clinical application of this technique: first, any relative migration of the iliac and sacral bone structures between computed tomography scans taken preoperatively and intraoperative navigation may result in an intolerable inaccuracy of computer guidance. Second, bending of the guide wire of the tracked power drive, which cannot be accommodated by the navigation system, will lead to misguidance; therefore, only navigated drill sleeves should be used.