case_images: PMC11823858_01
case_images: (a) Palpation of inner and outer table of the left ilium (b) The incision is made one finger breadth from the ASIS and then the stealth post is gently malleted in between the inner and outer table with the arrow pointing towards the feet (c) Ensure the stealth post is firmly secured and attach an array with the sensors viewable to the camera. (d) Before bringing the O-arm in for imaging, place two three-quarter drapes on each side of the stealth post and secure it with two nonpenetrating clamps proximally and distally. Then place a blue towel over the sensors.
case_images: JOCR-15-183-g001.jpg
case_images: PMC11823858_01_JOCR-15-183-g001.jpg
case_images: F1
case_images: For the Stealth navigation system, a small incision is made through the skin, overlying the palpable ilium, just one finger breadth proximal to the anterior superior iliac spine (Fig. 1a). The registration post is manually impacted into the ilium without predrilling, being mindful to mimic the trajectory of the iliac wing to keep the post within the inner and outer tables (Fig. 1b).The array is then attached and rotated to the appropriate number so that the sensors are viewable at all times by the Stealth unit (Fig. 1c). Next, the field is covered with two three-quarter sheets and clipped together around the array with a towel over the top of the array as the O-arm machine was brought in to maintain a sterile field (Fig. 1d).
case_images: (a) On the back table with the wire inserted into the aiming gun, the wire is marked with the anticipated screw length. (b and c) The location of your incision can be found using the navigated gun with the projected trajectory of the screw. (d) Once the navigated gun is placed into the incision and the proper trajectory is found, the wire is inserted up to the marked line of the anticipated screw length. (e) Predrilling of the near cortex. (f) Insertion of the iFuse-TORQ implant with navigated handle.
case_images: JOCR-15-183-g002.jpg
case_images: PMC11823858_01_JOCR-15-183-g002.jpg
case_images: F2
case_images: The navigated aiming gun is cannulated and allows real-time visualization of the guide wire for safety in placement (Fig. 2a, b, c). Initially, the navigated gun is used to find the rough starting point against the skin to allow appropriate incision placement (Fig. 2d). The aiming gun is then removed and the near cortex will require pre-drilling before moving to the contralateral side (Fig. 2e). The images are then confirmed for safe wire placement and also to determine if anticipated screw lengths were appropriate.At this time, the screws can be placed without navigation, or a calibrated sensor can be utilized to follow the screw depth insertion in real-time (Fig. 2f).
case_images: Final fluoroscopic images of the implants in good position.
case_images: JOCR-15-183-g003.jpg
case_images: PMC11823858_01_JOCR-15-183-g003.jpg
case_images: F3
case_images: Multiple radiographs are obtained (inlet, outlet, anteroposterior, and tangential views of the posterolateral ilium) to ensure that all screws are flush on bone and safe from the neural foramen (Fig. 3).