ArticleNorth American Spine Society journal2025
Obturator inlet and iliac oblique fluoroscopic views allow for placement of longer iliac screws.
Article in North American Spine Society journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Achieving strong distal fixation in posterior spinal fusion (PSF) surgeries sometimes necessitates iliac screw placement. However, traditional methods such as freehand and CT navigation techniques face limitations concerning screw length, accuracy, ergonomic challenges, surgical time, and drill deflection. Fluoroscopic iliac screw guidance using the obturator inlet and iliac oblique (OIIO) views may mitigate some of these drawbacks. Methods: This retrospective comparative study was conducted at a university-affiliated tertiary care hospital and Level 1 trauma center, reviewing cases from January 2020 to December 2022. A total of 119 patients who underwent posterior spinal fusion with pelvic fixation were included and categorized into 3 groups: OIIO ( Results: Screw lengths were 97.95 ± 6.95 mm, 78.68 ± 5.17 mm, and 85.27 ± 7.01 mm in the OIIO, freehand, and navigation groups, respectively (p < .0001). Despite the longer screws, the OIIO group had no cortical breaches, compared to 0.58% in the freehand group and 0% in the CT navigation group (p = .5683). No significant differences were observed in iliac screw revision rates across groups (p = .6175), suggesting the OIIO technique is not inferior to freehand and navigation-assisted methods regarding safety and screw length. Conclusions: The OIIO technique allows for favorable screw sizes compared to freehand and navigation-assisted methods without increasing cortical breach risk. This technique provides a safe and ergonomic alternative, particularly in settings where advanced navigation technology is unavailable.
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