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The upper sacral nerve root tunnel: an anatomic and clinical study.

Eric D Farrell1, Michael J Gardner, James C Krieg

  • 1Cooper Bone and Joint Institute, Camden, NJ, USA.

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|April 25, 2009
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Radiographic imaging consistently demonstrated the upper sacral nerve root tunnel (USNRT) in cadavers and patients. Understanding USNRT landmarks on pelvic outlet and lateral sacral views aids surgeons in avoiding iliosacral screw misplacement.

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Area of Science:

  • Anatomy
  • Radiology
  • Orthopedic Surgery

Background:

  • The upper sacral nerve root tunnel (USNRT) is a critical anatomical structure.
  • Accurate identification of the USNRT is essential for safe iliosacral screw placement in pelvic fracture fixation.

Purpose of the Study:

  • To radiographically demonstrate the upper sacral nerve root tunnel (USNRT).
  • To evaluate the clinical relevance of USNRT visualization in patients undergoing iliosacral screw insertion.

Main Methods:

  • Cadaveric pelves were imaged using standard pelvic radiographic views after contrast injection into the USNRT.
  • Twenty-three patients with pelvic ring disruptions underwent fluoroscopically assisted iliosacral screw insertion, with intraoperative USNRT visualization assessed.

Main Results:

  • Cadaveric studies confirmed consistent USNRT visualization on all radiographic views.
  • In patients, USNRTs were visualized on pelvic outlet views (100%) and true lateral sacral views (91%).
  • No extraosseous iliosacral screw placement occurred when using USNRT radiographic landmarks.

Conclusions:

  • The USNRT exhibits a consistent radiographic appearance, best visualized on pelvic outlet and true lateral sacral views.
  • Understanding USNRT anatomy and radiographic landmarks is crucial for preventing iliosacral screw tunnel intrusion.
  • This knowledge enhances surgical safety and accuracy in treating posterior pelvic ring disruptions.