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Lateral sacral imaging in the morbidly obese.

Anna N Miller1, James C Krieg, Milton L Chip Routt

  • 1Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA. anmiller@wakehealth.edu

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Obesity complicates surgery, especially imaging for morbidly obese patients. If the lateral sacrum is not visible on pre-operative CT scans, it will also be unseeable during surgery, impacting pelvic injury planning.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Obesity Medicine

Background:

  • Obesity presents significant challenges in surgical procedures, increasing both intraoperative difficulty and postoperative complication rates.
  • Intraoperative imaging in morbidly obese patients is often technically challenging, potentially compromising surgical accuracy and safety.

Purpose of the Study:

  • To investigate the relationship between pre-operative computed tomography (CT) visualization of the lateral sacrum and intraoperative fluoroscopic visualization in morbidly obese patients with pelvic ring injuries.
  • To highlight the implications of limited pre-operative imaging for surgical planning in this patient population.

Main Methods:

  • Retrospective review of pre-operative scout CT scans and intraoperative fluoroscopy images in morbidly obese patients with pelvic ring injuries.
  • Assessment of the visibility of the lateral sacrum on both imaging modalities.

Main Results:

  • A consistent finding was that if the lateral sacrum was not visualized on the pre-operative scout CT scan, it was also not visible on intraoperative fluoroscopy.
  • This inability to visualize the lateral sacrum impacts surgical planning for pelvic ring injuries.

Conclusions:

  • Pre-operative CT imaging is crucial for assessing the visibility of the lateral sacrum in morbidly obese patients.
  • The inability to visualize the lateral sacrum on pre-operative CT reliably predicts its non-visibility during intraoperative fluoroscopy, necessitating adjusted surgical planning for pelvic ring injuries in this demographic.