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Vet Comp Orthop Traumatol 2022; 35(02): 119-127
DOI: 10.1055/s-0041-1736648
Clinical Communication

Computed Tomographic Evaluation of the Accuracy of Minimally Invasive Sacroiliac Screw Fixation in Cats

Daniel J. Wills 
1   Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, Australia
,
Jack Neville-Towle
1   Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, Australia
,
Juan Podadera
1   Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, Australia
,
Kenneth A. Johnson 
1   Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, Australia
› Author Affiliations Funding The funding was provided for acquisition of the CT images from the Sydney School of Veterinary Science clinical residency research allowance.
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Abstract

Objectives The aim of this study was to report the use of computed tomography (CT) for postoperative evaluation of the accuracy of sacroiliac reduction and minimally invasive screw fixation in a series of five cats.

Methods Medical records between January 2016 and March 2017 of cats presenting to the author's institution were reviewed. Included were cats that had undergone minimally invasive sacroiliac screw fixation with a complete medical record and pre- and postoperative radiographs. Screw size was obtained from the medical records. CT images were acquired prospectively and evaluated to assess joint reduction, relative screw size and screw positioning.

Results Six sacroiliac luxations and 6 screws were available. Fixation was achieved with either a 2.4 (n = 1) or 2.7 mm (n = 5), 316L stainless steel, cortical bone screw. Mean screw size as a proportion of sacral diameter was 47.7%. Sacroiliac reduction >90% in the craniocaudal plane and sacral screw purchase >60% of the sacral width were achieved in 3/5 cases. Mean dorsoventral screw angulation was 1.6 degrees (range: −9.7 to 11.7 degrees) and craniocaudal angulation was −4.5 degrees (range: −16.6 to 6.6 degrees). Complications included screw loosening in the one case of bilateral repair and penetration of the neural canal in one case which was not detected with postoperative radiographic evaluation.

Clinical Significance CT evaluation provides a useful method for the assessment of sacroiliac reduction and the accuracy of screw placement.

Keywords

sacroiliac luxation - computed tomography - cats - minimally invasive approach - screw fixation

Authors' Contributions

D.J.W. and K.A.J. contributed to the conception of study, study design, acquisition of data, data analysis and interpretation, drafting or revising of manuscript, approval of submitted manuscript, and are publicly accountable for relevant content. J.N.-T. contributed to the acquisition of data, data analysis and interpretation and drafting or revising of manuscript while J.P. was involved in acquisition of data and data analysis and interpretation.


Note

A portion of this study was presented at the 47th Annual Conference of the Veterinary Orthopedic Society, Feb 1-8, 2020, Sun Valley, Idaho, United States.


Supplementary Material



Publication History

Received: 02 January 2021

Accepted: 21 September 2021

Article published online:
30 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bookbinder P, Flanders J. Characteristics of pelvic fracture in the cat. Vet Comp Orthop Traumatol 1992; 5 (03) 122-127
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Zulauf D, Kaser-Hotz B, Hässig M, Voss K, Montavon PM. Radiographic examination and outcome in consecutive feline trauma patients. Vet Comp Orthop Traumatol 2008; 21 (01) 36-40
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Hill FW. A survey of bone fractures in the cat. J Small Anim Pract 1977; 18 (07) 457-463
    CrossrefPubMedGoogle Scholar
  • 4 Lanz OI. Lumbosacral and pelvic injuries. Vet Clin North Am Small Anim Pract 2002; 32 (04) 949-962 , vii–viii
    CrossrefPubMedGoogle Scholar
  • 5 Meeson RL, Geddes AT. Management and long-term outcome of pelvic fractures: a retrospective study of 43 cats. J Feline Med Surg 2017; 19 (01) 36-41
    CrossrefPubMedGoogle Scholar
  • 6 Kaderly RE. Stabilization of bilateral sacroiliac fracture-luxations in small animals with a single transsacral screw. Vet Surg 1991; 20 (02) 91-96
    CrossrefPubMedGoogle Scholar
  • 7 Bird FG, de Vicente F. Conservative management of sacroiliac luxation fracture in cats: medium to long-term functional outcome. J Feline Med Surg 2020; 22 (06) 575-581
    CrossrefPubMedGoogle Scholar
  • 8 Burger M, Forterre F, Brunnberg L. Surgical anatomy of the feline sacroiliac joint for lag screw fixation of sacroiliac fracture-luxation. Vet Comp Orthop Traumatol 2004; 17 (03) 146-151
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Hamilton MH, Evans DA, Langley-Hobbs SJ. Feline ilial fractures: assessment of screw loosening and pelvic canal narrowing after lateral plating. Vet Surg 2009; 38 (03) 326-333
    CrossrefPubMedGoogle Scholar
  • 10 DeCamp CE. Principles of pelvic fracture management. Semin Vet Med Surg (Small Anim) 1992; 7 (01) 63-70
    PubMedGoogle Scholar
  • 11 Herron MR. Sarcoiliac luxations: methods of closed repair. Feline Pract 1976; 6: 46-49
    PubMedGoogle Scholar
  • 12 Piermattei D, Flo G, DeCamp C. Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. 4th edition.. St Louis: Elsevier; 2006: 436-440
    Google Scholar
  • 13 Kudnig S, Fitch R. Trans-ilial and transsacral brace fixation of sacral fractures and sacro-iliac luxations (seven cases). Vet Comp Orthop Traumatol 2004; 17 (04) 210-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Raffan PJ, Joly CL, Timm PG, Miles JE. A tension band technique for stabilisation of sacroiliac separations in cats. J Small Anim Pract 2002; 43 (06) 255-260
    CrossrefPubMedGoogle Scholar
  • 15 DeCamp CE, Braden TD. The surgical anatomy of the canine sacrum for lag screw fixation of the sacroiliac joint. Vet Surg 1985; 14 (02) 131-134
    CrossrefPubMedGoogle Scholar
  • 16 Hauptman J, Hulse D, Chitwood J. Indications for stabilization of sacroiliac luxations in the dog and cat. Vet Med Small Anim Clin 1976; 71 (10) 1413-1419
    PubMedGoogle Scholar
  • 17 Pratesi A, Grierson JM, Moores AP. Single transsacral screw and nut stabilization of bilateral sacroiliac luxation in 20 cats. Vet Comp Orthop Traumatol 2018; 31 (01) 44-52
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Johnson KA. Piermattei's Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. 5th edition.. Philadelphia: Saunders; 2014
    Google Scholar
  • 19 Borer LR, Voss K, Montavon PM. Ventral abdominal approach for screw fixation of sacroiliac luxation in clinically affected cats. Am J Vet Res 2008; 69 (04) 549-556
    CrossrefPubMedGoogle Scholar
  • 20 DeCamp CE, Braden TD. Sacroiliac fracture-separation in the dog: a study of 92 cases. Vet Surg 1985; 14 (02) 127-130
    CrossrefPubMedGoogle Scholar
  • 21 Tonks CA, Tomlinson JL, Cook JL. Evaluation of closed reduction and screw fixation in lag fashion of sacroiliac fracture-luxations. Vet Surg 2008; 37 (07) 603-607
    CrossrefPubMedGoogle Scholar
  • 22 Tomlinson JL, Cook JL, Payne JT, Anderson CC, Johnson JC. Closed reduction and lag screw fixation of sacroiliac luxations and fractures. Vet Surg 1999; 28 (03) 188-193
    CrossrefPubMedGoogle Scholar
  • 23 Rollins A, Balfour R, Szabo D, Chesvick CM. Evaluation of fluoroscopic-guided closed reduction versus open reduction of sacroiliac fracture-luxations stabilized with a lag screw. Vet Comp Orthop Traumatol 2019; 32 (06) 467-474
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Déjardin LM, Marturello DM, Guiot LP, Guillou RP, DeCamp CE. Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation. Vet Comp Orthop Traumatol 2016; 29 (04) 290-297
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Averill SM, Johnson AL, Schaeffer DJ. Risk factors associated with development of pelvic canal stenosis secondary to sacroiliac separation: 84 cases (1985-1995). J Am Vet Med Assoc 1997; 211 (01) 75-78
    CrossrefPubMedGoogle Scholar
  • 26 Tomlinson J. Minimally invasive repair of sacroiliac luxation in small animals. Vet Clin North Am Small Anim Pract 2012; 42 (05) 1069-1077 , viii
    CrossrefPubMedGoogle Scholar
  • 27 Déjardin LM, Fauron AH, Guiot LP, Guillou RP. Minimally invasive lag screw fixation of sacroiliac luxation/fracture using a dedicated novel instrument system: apparatus and technique description. Vet Surg 2018; 47 (01) 93-103
    CrossrefPubMedGoogle Scholar
  • 28 Shuler TE, Boone DC, Gruen GS, Peitzman AB. Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma 1995; 38 (03) 453-458
    CrossrefPubMedGoogle Scholar
  • 29 Sciulli RL, Daffner RH, Altman DT, Altman GT, Sewecke JJ. CT-guided iliosacral screw placement: technique and clinical experience. AJR Am J Roentgenol 2007; 188 (02) W181-92
    CrossrefPubMedGoogle Scholar
  • 30 Smith AG, Capobianco R, Cher D. et al. Open versus minimally invasive sacroiliac joint fusion: a multi-center comparison of perioperative measures and clinical outcomes. Ann Surg Innov Res 2013; 7 (01) 14
    CrossrefPubMedGoogle Scholar
  • 31 Ledonio CG, Polly Jr DW, Swiontkowski MF. Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective?. Clin Orthop Relat Res 2014; 472 (06) 1831-1838
    CrossrefPubMedGoogle Scholar
  • 32 Shales CJ, White L, Langley-Hobbs SJ. Sacroiliac luxation in the cat: defining a safe corridor in the dorsoventral plane for screw insertion in lag fashion. Vet Surg 2009; 38 (03) 343-348
    CrossrefPubMedGoogle Scholar
  • 33 Draffan D, Clements D, Farrell M, Heller J, Bennett D, Carmichael S. The role of computed tomography in the classification and management of pelvic fractures. Vet Comp Orthop Traumatol 2009; 22 (03) 190-197
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Pentreath RJ, Applegate KE, Higley KA. et al. Radiological protection of the patient in veterinary medicine and the role of ICRP. Ann ICRP 2020; 49 (1_suppl): 169-181
    CrossrefPubMedGoogle Scholar
  • 35 Brady SL, Mirro AE, Moore BM, Kaufman RA. How to appropriately calculate effective dose for CT using either size-specific dose estimates or dose-length product. AJR Am J Roentgenol 2015; 204 (05) 953-958
    CrossrefPubMedGoogle Scholar
  • 36 Lee MJ, Kim S, Lee SA. et al. Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics 2007; 27 (03) 791-803
    CrossrefPubMedGoogle Scholar
  • 37 Bowlt KL, Shales CJ. Canine sacroiliac luxation: anatomic study of the craniocaudal articular surface angulation of the sacrum to define a safe corridor in the dorsal plane for placement of screws used for fixation in lag fashion. Vet Surg 2011; 40 (01) 22-26
    CrossrefPubMedGoogle Scholar
  • 38 Philp H, Durand A, De Vicente F. Use of computed tomography to define a sacral safe corridor for placement of 2.7 mm cortical screws in feline sacroiliac luxation. J Feline Med Surg 2018; 20 (06) 487-493
    CrossrefPubMedGoogle Scholar
  • 39 Zwingmann J, Konrad G, Kotter E, Südkamp NP, Oberst M. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 2009; 467 (07) 1833-1838
    CrossrefPubMedGoogle Scholar
  • 40 Shales C, Moores A, Kulendra E, White C, Toscano M, Langley-Hobbs S. Stabilization of sacroiliac luxation in 40 cats using screws inserted in lag fashion. Vet Surg 2010; 39 (06) 696-700
    PubMedGoogle Scholar
  • 41 Fischer A, Binder E, Reif U, Biel M, Bokemeyer J, Kramer M. Closed reduction and percutaneous fixation of sacroiliac luxations in cats using 2.4 mm cannulated screws - a cadaveric study. Vet Comp Orthop Traumatol 2012; 25 (01) 22-27
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Gregory CR, Cullen JM, Pool R, Vasseur PB. The canine sacroiliac joint. Preliminary study of anatomy, histopathology, and biomechanics. Spine 1986; 11 (10) 1044-1048
    CrossrefPubMedGoogle Scholar