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Related Experiment Video

Updated: Feb 28, 2026

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Probabilistic Safe Zone Mapping for S1 Screw Placement Using 1000 Lumbosacral CT Scans: A Study Protocol for a

Nikolai Ramadanov1,2, Robert Hable3, Simon Zabler3

  • 1Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School, Hochstraße 29, 14770 Brandenburg an der Havel, Germany.

Journal of Clinical Medicine
|February 27, 2026
PubMed
Summary

This study develops a probabilistic, computed tomography (CT)-based safe zone model for sacral vertebra 1 (S1) screw placement. The model provides quantitative probability estimates to enhance surgical planning and decision-making for lumbosacral and iliosacral fixation.

Keywords:
anatomycomputed tomographycross-sectionaliliosacral fixationprobabilitysacral vertebraesacrumscrew fixationsurgical planning

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Area of Science:

  • Spinal surgery
  • Orthopedic biomechanics
  • Medical imaging analysis

Background:

  • Safe sacral vertebra 1 (S1) screw placement is critical for lumbosacral and iliosacral fixation.
  • Current anatomical safe zones lack quantitative probability estimates for deviations from ideal entry points.
  • A need exists for probabilistic models to guide S1 screw placement.

Purpose of the Study:

  • To develop a probabilistic, computed tomography (CT)-based safe zone model for S1 screw placement.
  • To provide quantitative probability estimates for permissible deviations from ideal S1 screw entry points.
  • To enhance preoperative planning and intraoperative decision-making in spinal surgery.

Main Methods:

  • Retrospective analysis of 1000 anonymized lumbosacral CT scans.
  • Definition of a reference entry point and evaluation of bilateral offset-based virtual screw trajectories.
  • Generation of probabilistic safety maps based on intraosseous/extraosseous classifications and interobserver reliability assessment.

Main Results:

  • Expected generation of continuous probabilistic safety maps for S1 screw placement.
  • Anticipated demonstration of a gradual transition from high to low safety probabilities.
  • Identification of anatomical factors influencing screw containment and intraosseous placement.

Conclusions:

  • The study proposes a novel CT-based probabilistic modeling approach for S1 screw placement.
  • This method offers a more nuanced and quantitative definition of anatomical safe zones.
  • The probabilistic model aims to improve surgical outcomes by informing preoperative planning and intraoperative guidance.