Anatomical considerations for percutaneous trans ilio-sacroiliac S1 and S2 screw placement

To determine the presence of a consistent osseous corridor through S1 and S2 and fluoroscopic landmarks thereof, which could be used for safe trans ilio-sacroiliac screw fixation of posterior pelvic ring disorders.

Computed tomography (CT) based anatomical investigation utilising multiplanar image and trajectory reconstruction (Agfa-IMPAX Version 5.2 software). Determination of the presence and dimension of a continuous osseous corridor in the coronal plane of the sacrum at the S1 and S2 vertebral levels.

Determination of: (a) the presence of an osseous corridor in the coronal plane through S1 and S2 in males and females; (b) the dimension of the corridor with regard to diameter and length; (c) the fluoroscopic landmarks of the corridor.

The mean cross-sectional area for S1 corridors in males and females was 2.13 and 1.47 cm(2) , respectively. The mean cross-sectional area for the S2 corridor in males and females was 1.46 and 1.13 cm(2), respectively. The limiting anatomical factor is the sagittal diameter of the sacral ala at the junction to the vertebral body. The centre of the S1 and S2 corridor is located in close proximity to the centre of the S1 and S2 vertebrae on the lateral fluoroscopic view as determined by the adjacent endplates and anterior and posterior vertebral cortices.

Two-thirds of males and females have a complete osseous corridor to pass a trans-sacroiliac S1 screw of 8 mm diameter. The S2 corridor was present in all males but only in 87 % of females. Preoperative review of the axial CT slices at the midpoint of the S1 or S2 vertebral body allows the presence of a trans-sacroiliac osseous corridor to be determined by assessing the passage at the narrowest point of the corridor at the junction of the sacral ala to the vertebral body.