Center for Spine Surgery, Neckar-Odenwald-Kliniken gGmbH Buchen, Buchen, Germany.
Clin Spine Surg. 2021 Oct 1;34(8):286-290. doi: 10.1097/BSD.0000000000001226.
Nondisplaced and minimally displaced sacral insufficiency fractures are increasingly being recognized as a cause of immobilizing low back pain in the elderly. These insufficiency fractures are most accurately diagnosed by visualizing sacral bone marrow edema on magnetic resonance imaging, which is the radiologic imaging modality with the highest sensitivity for identifying these fractures. Successful treatment options range from nonsurgical (eg, bed rest, pain medication, mobilization, antiosteoporotic medication, low-intensity-pulsed ultrasound, etc.) to surgical management (ie, sacroplasty and/or osteosynthesis with iliosacral screws or lumbosacral hinge fixation with or without application of reinforcing bone cement). The appropriate surgical treatment for frail subjects requires a less-invasive technique that establishes full weight-bearing stability for successful early remobilization of affected elderly and multimorbid individuals. Iliosacral screw osteosynthesis with a single C-arm is a common surgical technique for stabilizing the posterior pelvic ring after traumatic instabilities or fractures of the sacrum. Bilateral injuries are generally addressed from both sides of the pelvis. This article describes the surgical technique of 3D image-guided transsacral screw fixation for unilateral and bilateral nondisplaced sacral insufficiency fractures in the elderly using a single-sided approach, and specifies the associated preoperative and postoperative management. The procedure is illustrated in an instructional video that demonstrates step-by-step, how the navigated surgical procedure is performed.
无移位和轻度移位的骶骨骨质疏松性骨折越来越多地被认为是导致老年人腰痛的原因。这些骨质疏松性骨折最准确的诊断方法是通过磁共振成像（MRI）观察骶骨骨髓水肿，MRI 是识别这些骨折的敏感性最高的影像学检查方法。成功的治疗方案包括非手术治疗（如卧床休息、止痛药物、活动、抗骨质疏松药物、低强度脉冲超声等）和手术治疗（即骨水泥强化骶骨成形术和/或经髂骨螺钉固定或腰骶关节铰链固定）。对于体弱患者，适当的手术治疗需要一种微创技术，为成功的早期康复提供全负重稳定性，使受影响的老年和多病患者能够早期活动。单 C 臂髂骨螺钉内固定术是一种常见的手术技术，用于稳定创伤性不稳定或骶骨骨折后的骨盆后环。双侧损伤通常从骨盆两侧进行处理。本文描述了使用单侧入路对老年单侧和双侧无移位骶骨骨质疏松性骨折进行 3D 图像引导经骶骨螺钉固定的手术技术，并详细说明了相关的术前和术后管理。该手术过程通过教学视频进行了演示，逐步展示了导航手术过程的操作方法。
