Proposed alternative revision strategy for broken S1 pedicle screw: radiological study, review of the literature, and case reports

Abstract Background context There have been many reports outlining differing methods for managing a broken S1 screw. To the authors' best knowledge, the technique used in the present study has not been described previously. It involves insertion of a second pedicle screw without removing the broken screw shaft. Study design Radiological study, literature review, and two case reports of the surgical technique. Purpose To report a proposed new surgical technique for management of broken S1 pedicle screws. Methods Computed tomography (CT) scans of 50 patients with a total of 100 S1 pedicles were analyzed. There were 25 male and 25 female patients with an average age of 51 years ranging from 36 to 68 years. The cephalad-caudal length, medial-lateral width, and cross-sectional area of the S1 pedicle were measured and compared with the diameter of a pedicle screw to illustrate the possibility of inserting a second screw in S1 pedicle without removal of the broken screw shaft. Two case reports of the proposed technique are presented. Results The left and right S1 pedicle cross-sectional area in female measured 456.00±4.00 and 457.00±3.00 mm2 , respectively. The left and right S1 pedicle cross-section area in male measured 638.00±2.00 and 639.00±1.00 mm2 , respectively. There were statistically significant differences when comparing male and female S1 pedicle length, width, and cross-sectional area (p