Navigated Transsacral Screw Fixation for the Treatment of Bilateral Sacral Insufficiency Fractures

Nondisplaced and minimally displaced sacral insufficiency fractures are increasingly being recognized as a cause of immobilizing low back pain in the elderly. These insufficiency fractures are most accurately diagnosed by visualizing sacral bone marrow edema on magnetic resonance imaging, which is the radiologic imaging modality with the highest sensitivity for identifying these fractures. Successful treatment options range from nonsurgical (eg, bed rest, pain medication, mobilization, antiosteoporotic medication, low-intensity-pulsed ultrasound, etc.) to surgical management (ie, sacroplasty and/or osteosynthesis with iliosacral screws or lumbosacral hinge fixation with or without application of reinforcing bone cement). The appropriate surgical treatment for frail subjects requires a less-invasive technique that establishes full weight-bearing stability for successful early remobilization of affected elderly and multimorbid individuals. Iliosacral screw osteosynthesis with a single C-arm is a common surgical technique for stabilizing the posterior pelvic ring after traumatic instabilities or fractures of the sacrum. Bilateral injuries are generally addressed from both sides of the pelvis. This article describes the surgical technique of 3D image-guided transsacral screw fixation for unilateral and bilateral nondisplaced sacral insufficiency fractures in the elderly using a single-sided approach, and specifies the associated preoperative and postoperative management. The procedure is illustrated in an instructional video that demonstrates step-by-step, how the navigated surgical procedure is performed.