• Daniel Behrendt, Maria Mütze, Hanno Steinke, Martin Koestler, Christoph Josten, and Jörg Böhme.
• Department of Trauma, Reconstructive and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. daniel.behrendt@medizin.uni-leipzig.de
• Int J Comput Assist Radiol Surg. 2012 Mar 1;7(2):249-55.

PurposeImage guidance is essential in some orthopedic surgical procedures, especially iliosacral screw fixation. Currently, there is no consensus regarding the best image guidance technique. An ex-vivo study was performed to compare conventional, 2-dimensional (2D), and 3D imaging techniques and determine the optimal image guidance technique for pelvic surgery.MethodsPlastic (n = 9) and donated cadaver pelvises (n = 8) were evaluated in the laboratory. The pelvises were positioned on radiolucent operation tables in a prone position. Transiliosacral screws were inserted without or with 2D- and 3D-navigational support. A digital mobile X-ray unit with flat-panel fluoroscopy and navigation software was used to measure precision, radiation exposure, and time requirements.Results2D-navigation resulted in 40% incorrect screw positioning for the cadavers, 6% for the plastic phantoms, and 21% overall. The highest accuracy was accomplished with 3D-navigation (plastic: 100%; cadavers: 83%; p < 0.05). The dose-area product showed that both 2D- and 3D-navigation required increased exposure compared to the conventional technique (p < 0.01). For both plastic and cadaver specimens, navigated techniques required significantly longer times for screw insertion than the conventional technique (p < 0.01).Conclusion3D image guidance for transiliosacral screw fixation enabled more accurate screw placement in S1 and S2 vertebrae. However, radiation exposure in 3D-navigation was excessive; thus, we recommend avoiding 3D-navigation in young patients. A primary advantage of 3D-navigation was that the operating team could leave the room during the scan; thus, it reduced their radiation exposure. Moreover, the time required for screw insertion with 3D-navigation was similar to that required in the conventional technique; thus, 3D-navigation is recommended for older patients.

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