Determination of a neurologic safe zone for bicortical S1 pedicle screw placement

Determination of a neurologic safe zone for bicortical S1 pedicle screw placement

Lumbosacral fixation is commonly used for the management of lumbosacral instability. As the sacrum mainly consists of cancellous bone, bicortical fixation, in which the pedicle screw penetrates the anterior sacral cortex, can help increase the strength of fixation. However, this method carries a ris...

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Veröffentlicht in:The spine journal 2022-10, Vol.22 (10), p.1708-1715
Hauptverfasser: Coskun, Ergin, Wellington, Ian J., Bellas, Nicholas, Singh, Hardeep, Mallozzi, Scott S., Cote, Mark P., Moss, Isaac L.
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Anatomy
Fusion
Lumbar
Nerve
Pedical screw
Safe zone
Trajectory
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container_end_page 1715
container_issue 10
container_start_page 1708
container_title The spine journal
container_volume 22
creator Coskun, Ergin
Wellington, Ian J.
Bellas, Nicholas
Singh, Hardeep
Mallozzi, Scott S.
Cote, Mark P.
Moss, Isaac L.
description Lumbosacral fixation is commonly used for the management of lumbosacral instability. As the sacrum mainly consists of cancellous bone, bicortical fixation, in which the pedicle screw penetrates the anterior sacral cortex, can help increase the strength of fixation. However, this method carries a risk to the L5 nerves which lie anterior to the sacrum at this level. The goal of this study is to determine a safe zone for the placement of S1 pedicle screws to decrease the likelihood of L5 nerve injury. Retrospective imaging review. This study evaluated imaging data of patients who underwent lumbar spine magnetic resonance imaging (MRI) at our institute between September 1, 2020 and September 1, 2021. T1-weighted axial MRIs were measured at the level of S1 pedicle screw placement. The space medial and lateral to the L5 nerve root on the anterior sacrum were measured and defined as safe zones. Additionally, the nerve width and sacral lengths were measured at this level. The distribution of the measurements were evaluated to determine a medial and lateral safe zone, as well as the average nerve width at the level of S1 pedicle screw placement. Correlation analysis was performed to determine a relationship between safe zone sizes and sacral size. A total of 400 MRIs were analyzed. The average medial safe zone measured was 32.8 mm (95% CI: 32.2–33.4) with no nerves lying within 22.3 mm of the midline sacrum. The average lateral safe zone measured was 17.7 mm (95% CI: 17.1–18.2), with no nerves within 5.3 mm of the lateral border of the sacrum. The average nerve root width was 6.2 mm (95% CI: 6.13–6.34). An increased sacral length was associated with a larger medial (p
doi_str_mv 10.1016/j.spinee.2022.04.016
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As the sacrum mainly consists of cancellous bone, bicortical fixation, in which the pedicle screw penetrates the anterior sacral cortex, can help increase the strength of fixation. However, this method carries a risk to the L5 nerves which lie anterior to the sacrum at this level. The goal of this study is to determine a safe zone for the placement of S1 pedicle screws to decrease the likelihood of L5 nerve injury. Retrospective imaging review. This study evaluated imaging data of patients who underwent lumbar spine magnetic resonance imaging (MRI) at our institute between September 1, 2020 and September 1, 2021. T1-weighted axial MRIs were measured at the level of S1 pedicle screw placement. The space medial and lateral to the L5 nerve root on the anterior sacrum were measured and defined as safe zones. Additionally, the nerve width and sacral lengths were measured at this level. The distribution of the measurements were evaluated to determine a medial and lateral safe zone, as well as the average nerve width at the level of S1 pedicle screw placement. Correlation analysis was performed to determine a relationship between safe zone sizes and sacral size. A total of 400 MRIs were analyzed. The average medial safe zone measured was 32.8 mm (95% CI: 32.2–33.4) with no nerves lying within 22.3 mm of the midline sacrum. The average lateral safe zone measured was 17.7 mm (95% CI: 17.1–18.2), with no nerves within 5.3 mm of the lateral border of the sacrum. The average nerve root width was 6.2 mm (95% CI: 6.13–6.34). An increased sacral length was associated with a larger medial (p&lt;.001) and lateral (p&lt;.001) safe zone. Our study revealed lateral and medial safe zones for the placement of S1 pedicle screws to avoid iatrogenic nerve injury in a retrospective cohort of 400 patients. There were no L5 nerve roots found within 22.3 mm of the sacrum's mid-axis or within 5.3 mm of the sacrum's anterolateral border. These defined safe zones can be used during pedicle screw planning and placement to decrease the risk of injury to the L5 nerve root.</description><identifier>ISSN: 1529-9430</identifier><identifier>EISSN: 1878-1632</identifier><identifier>DOI: 10.1016/j.spinee.2022.04.016</identifier><identifier>PMID: 35504567</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anatomy ; Fusion ; Lumbar ; Nerve ; Pedical screw ; Safe zone ; Trajectory</subject><ispartof>The spine journal, 2022-10, Vol.22 (10), p.1708-1715</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. 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As the sacrum mainly consists of cancellous bone, bicortical fixation, in which the pedicle screw penetrates the anterior sacral cortex, can help increase the strength of fixation. However, this method carries a risk to the L5 nerves which lie anterior to the sacrum at this level. The goal of this study is to determine a safe zone for the placement of S1 pedicle screws to decrease the likelihood of L5 nerve injury. Retrospective imaging review. This study evaluated imaging data of patients who underwent lumbar spine magnetic resonance imaging (MRI) at our institute between September 1, 2020 and September 1, 2021. T1-weighted axial MRIs were measured at the level of S1 pedicle screw placement. The space medial and lateral to the L5 nerve root on the anterior sacrum were measured and defined as safe zones. Additionally, the nerve width and sacral lengths were measured at this level. 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As the sacrum mainly consists of cancellous bone, bicortical fixation, in which the pedicle screw penetrates the anterior sacral cortex, can help increase the strength of fixation. However, this method carries a risk to the L5 nerves which lie anterior to the sacrum at this level. The goal of this study is to determine a safe zone for the placement of S1 pedicle screws to decrease the likelihood of L5 nerve injury. Retrospective imaging review. This study evaluated imaging data of patients who underwent lumbar spine magnetic resonance imaging (MRI) at our institute between September 1, 2020 and September 1, 2021. T1-weighted axial MRIs were measured at the level of S1 pedicle screw placement. The space medial and lateral to the L5 nerve root on the anterior sacrum were measured and defined as safe zones. Additionally, the nerve width and sacral lengths were measured at this level. 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source Elsevier ScienceDirect Journals Complete
subjects Anatomy
Fusion
Lumbar
Nerve
Pedical screw
Safe zone
Trajectory
title Determination of a neurologic safe zone for bicortical S1 pedicle screw placement
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