Abstract
Dysmorphic pelves are a known risk factor for malpositioned iliosacral screws. Improved understanding of pelvic morphology will minimise the risk of screw misplacement, neurovascular injuries and failed fixation. Existing classifications for sacral anatomy are complex and impractical for clinical use. We propose a CT-based classification using variations in pelvic anatomy to predict the availability of transosseous corridors across the sacrum. The classification aims to refine surgical planning which may reduce the risk of surgical complications.
The authors postulated 4 types of pelves. The “superior most point of the sacroiliac joint” (sSIJ) typically corresponds with the mid-lower half of the L5 vertebral body. Hence, “the anterior cortex of L5” (L5a) was divided to reference 3 distinct pelvic groups. A 4th group is required to represent pelves with a lumbosacral transitional vertebra. The proposed classification:
A – sSIJ is above the midpoint of L5a
B – sSIJ is between the midpoint and the lowest point of L5a
C – sSIJ is below the lowest point of L5a
D – pelves with a lumbosacral transitional vertebra
Specific measures such as the width of the S1 and S2 axial and coronal corridors and the S1 lateral mass angles were used to differentiate between pelvic types.
Three-hundred pelvic CT scans were classified into their respective types. Analysis of the specific measures mentioned above illustrated the significant difference between each pelvic type. Changes in the size of S1 and S2 axial corridors formed a pattern that was unique for each pelvic type. The intra- and inter-observer ratings were 0.97 and 0.95 respectively.
Distinct relationships between the sizes of S1 and S2 axial corridors informed our recommendations on trans-sacral or iliosacral fixation, number and orientation of screws for each pelvic type. This classification utilises variations in the posterior pelvic ring to offer a planning guide for the insertion of iliosacral screws.
