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Radiographically ‘safe’ screw pathways found for iliosacral screw at S1 in children
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Radiographically ‘safe’ screw pathways — defined as those that traverse from the ilium to the sacral or that pass from the ipsilateral ilium through the sacrum into the contralateral ilium — were found in most children for an iliosacral screw at S1 and for a transsacral transiliac screw at S2; however, half of children had an available pathway for a transsacral transiliac screw at S1, according to results.
Using the Centricity PACS system (GE Healthcare), researchers identified CT scans that included views of the sacrum in 174 children aged 2 years to 16 years. Researchers measured the width and height bilaterally at the constriction point in three safe screw pathways corresponding to an iliosacral screw at S1, a transsacral transiliac (TSTI) screw at S1 and a TSTI screw at S2.
Joshua L. Gary
Results showed all measurements had an interrater reliability coefficient above 0.917. Researchers found radiographically safe pathways in 99% of children for iliosacral screws at S1, 51% for TSTI screws at S1 and 89% for TSTI at S2. Compared with width, a trend toward a significantly faster rate of increase in pathway height with age was noted for iliosacral segments at S1 and TSTI S1, and TSTI at S2 had a significantly faster rate of increase in pathway height with age.
By visual assessment alone, researchers noted a 22% prevalence of dysmorphic traits at the upper sacral segment. When measurement thresholds were used, sacral dysmorphism was found in 20.1% of children and 32.2% of children had abnormal sacral morphology, according to results. Researchers found dysmorphic sacra in 39 children with pathway availability in 0% for TSTI screws at S1 and 87% at TSTI screws at S2. Non-dysmorphic sacra were found in 135 children, with pathway availability in 66% for TSTI screws at S1 and 89% for TSTI screws at S2. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
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