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A 73-year-old man experienced immediate neurological decline after percutaneous transsacral screw fixation for a pelvic ring injury sustained after a 25-foot fall. Workup revealed well-positioned screws and compression of the right L5 and S1 nerve roots at the fracture site. Symptoms improved after direct decompression without screw revision. The courses of the L5 and S1 nerve roots place them at risk of compression within the fracture during transsacral screw fixation. In highly comminuted fractures, avoidance of compression screws o