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Evidence-based support for S1 transpedicular screw entry point modification.

Lukasz Kubaszewski¹, Andrzej Nowakowski, Jacek Kaczmarczyk

¹Department of Orthopaedic and Traumatology, W, Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956 r Street, Poznań 61-545, Poland. pismiennictwo1@gmail.com.

Journal of Orthopaedic Surgery and Research

|April 9, 2014

Summary

A modified technique for S1 screw placement, shifting the starting point medially, may improve stability and reproducibility, especially in osteoporotic patients. This approach leverages anatomical data without increasing spinal canal perforation risk.

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Area of Science:

Spinal surgery
Orthopedic biomechanics
Anatomical studies

Background:

The standard technique for S1 screw placement is 'below and lateral to the superior S1 facet'.
Alternative starting points for S1 screw insertion have not been extensively analyzed or evaluated.
Surgeons report using modifications, but these lack systematic investigation.

Purpose of the Study:

To analyze anatomical and radiological data to determine the optimal starting point for transpedicular S1 screw placement.
To evaluate potential modifications to the standard S1 screw insertion technique.

Main Methods:

A Medline search identified 26 relevant publications using keywords: sacrum, anatomy, pedicle, screws, and bone density.
Two selected articles provided appropriate data for analysis.
Analysis focused on the spatial relationship of the S1 facet, pedicles, and vertebral body, considering cortical thickness and bone density in normal, osteopenic, and osteoporotic sacra.

Main Results:

Data suggests a more medial screw placement due to higher bone density and reduced bone loss in osteoporosis.
A medial shift in the starting point does not elevate the risk of spinal canal perforation.
Osteoarthritic facet changes can enhance the posterior support for the screw, and facet orientation aligns with a convergent screw trajectory.

Conclusions:

A modified technique for S1 screw placement is proposed, informed by current anatomical and clinical data.
This modification potentially enhances reproducibility and screw stability within the posterior cortex of the S1 vertebra.
Further biomechanical and clinical studies are recommended to validate the superiority of the modified technique over the classical approach.