Mean S1 inlet and outlet view angles are not safe for all individuals according to three-dimensional tomographic measurements

Abstract

Although there are many studies evaluating optimal inlet and outlet angles required for the correct placement of S1 iliosacral screws, there is no study evaluating reliability and feasibility of these angles for all individuals on three-dimensional (3D) anatomical models. A total of 100 women and 100 men were selected randomly. A vertical line was created according to long axis of the tomography device on which patient was lying in supine position. The automatized best-fit planes were created on superior and inferior endplates, anterior cortex including notch region and posterior cortex of first sacral vertebrae using 3D imaging software to measure mean inlet and outlet angles. We observed no statistically significant difference between gender groups in terms of inlet and outlet angles. Mean inlet view is obtained for anterior cortex of S1 in 22.5 +/- 9.5(degrees) and for posterior cortex in 46.5 +/- 9.3(degrees). Mean fluoroscopic view angle of S1 for superior outlet is 40.3 +/- 7.6 and for inferior outlet is 46.9 +/- 8.8. Mean anterior and posterior S1 inlet view angles do not accurately visualize anterior cortex of 74 (37%) and posterior cortex of 66 (33%) individuals. Mean superior and inferior S1 outlet view angles do not accurately visualize superior endplate of 74 (37%) and inferior endplate of 56 (28%) individuals. Due to individual alterations of spatial position of sacrum, mean inlet and outlet view angles of S1 are not sufficient to visualize the iliosacral screws under fluoroscopy in many individuals.