Document Type : Original Article
Neurosurgery department, Suez Canal University, Egypt.
Background Data: Although most sacral fractures can be treated conservatively, several surgical options are available for highly unstable fractures. Surgery aims to provide sacral realignment, fixation, and maybe neural decompression with subsequent pain relief and early mobilization. Surgical options are variable depending on the type of fractures and surgeon’s experience. Spinopelvic fixation is one of the famous surgical procedures.
Purpose: To evaluate the safety and efficacy of lumbopelvic fixation for the treatment of unstable traumatic spinopelvic sacral fractures.
Study Design: Prospective cohort study.
Patients and Methods: All patients with unstable spinopelvic sacral fractures excluding those with other types of sacral fractures were recruited for this study. All patients were submitted to lumbopelvic fixation. Patients were evaluated clinically and radiologically, including full lumbar and pelvis X-Ray and 3D MSCT scan at the pre- and postoperative period. Clinical parameters included a full neurological examination, VAS, ODI, and modified Rankin scale.
Results: A total of 15 patients including 7 males and 8 females with mean age of 28±8.11 years were recruited for this study. All patients were suffering from unstable traumatic spinopelvic type C sacral fractures according to AO Spine sacral fractures classification system. Four patients suffered from type C0, 2 from C1, 4 from C2, and 5 from C3. Neural insults were reported in 13 patients. The mean follow-up period was 19.2±8.6 (range, 6–36) months. The mean preoperative VAS improved from 8.13±1.25 to 2.6±1.01 postoperatively, while the mean preoperative ODI improved from 88.53±2.24 to 16.8±3.16 postoperatively. According to the modified Rankin scale for functional recovery, 14 (93.3%) of the patients were categorized as excellent and good, while only one patient (6.6%) was categorized as fair outcome. Complete fractures’ healing was reported in all patients and none required any revision procedure. Deformity correction was incomplete in 40% without clinical effects on patients. Surgical site infection was reported in 3 patients and one of them necessitated debridement.
Conclusion: Lumbopelvic fixation is a safe and effective procedure in the treatment of unstable traumatic spinopelvic sacral fractures. (2019ESJ196)