Variations in sacral morphology and implications for iliosacral screw fixation

Area of Science:

• Orthopedic Surgery
• Anatomy
• Radiology

Background:

• Posterior pelvic fixation is a common surgical procedure.
• Safe and effective surgery relies on detailed knowledge of posterior pelvic anatomy and its variations.
• Imaging plays a critical role in surgical planning and execution.

Purpose of the Study:

• To highlight the key anatomical characteristics of a dysmorphic sacrum.
• To emphasize the importance of recognizing anatomical variations for surgical safety.
• To guide surgeons in ensuring accurate iliosacral screw placement.

Main Methods:

• Review of posterior pelvic anatomy and common variations.
• Analysis of radiographic and CT imaging features associated with dysmorphic sacra.
• Correlation of anatomical knowledge with surgical screw placement.

Main Results:

• Dysmorphic sacra exhibit specific radiographic features including sacral alignment, mammillary bodies, non-circular foramina, residual disks, and alar slope.
• CT imaging can reveal a tongue-in-groove sacroiliac joint surface.
• Inlet views may show cortical indentation of the anterior ala.

Conclusions:

• Thorough understanding of individual sacral anatomy is essential for safe posterior pelvic percutaneous fixation.
• Awareness of dysmorphic sacral characteristics aids in preventing surgical complications.
• Precise iliosacral screw placement depends on detailed anatomical knowledge.