Minimally Invasive Iliac Screw Insertion: Clinical Case Series and Technical Note

Objective: Iliac screw fixation has numerous indication and techniques. To describe the technique of minimally invasive screw insertion of the iliac screw by freehand and navigated iliac screw placement using intraoperative image guidance.Methods: Bilateral iliac screws were inserted in a total of seven patients. Five patients underwent navigation guided iliac screw placement and the freehand technique was used in 2 patients. Results: A total of 7 patients underwent minimally invasive iliac screw fixation in our series. The pathology in 4 of the cases was spondylodiscitis, among them 2 cases each at L5-S1 and L4-L5, one with the destruction of L5 vertebral body and the other with the destruction of both L4 and L5 vertebral bodies. Of the remaining cases, two cases had sacral insufficiency fracture and the last case was implant failure after L2-L5 oblique lumbar fusion. None of the cases required conversion to open procedure and none had wound or hardware related complications till the last follow-up. All patients had an uneventful post-operative period with improvement in pain scores and were mobilized on the 1st postoperative day. One 50-year-old female patient suffering from L5-S1 tubercular spondylodiscitis died due to underlying chronic kidney disease three months post-surgery. Conclusion: Minimal invasive iliac screw placement with or without navigation offers the same biomechanical stability as the open approach but without the need for extensive soft tissue exposure needed for a conventional/open procedure; thereby reducing exposure-related complications and enhancing post-operative recovery and early mobilization. Incorporating intra-operative 3D navigation provides real-time multi-planar images which help in easy planning and safe screw placement whilst reducing radiation exposure.