Ilio-sacral Stabilization of Sacral Jumper's Fractures using the AO-Spine Fracture System: A Novel Surgical Technique

Abstract

IntroductionJumper's fractures are severe dissociation injuries of the spinopelvic junction. These U-shaped fractures are due to an axial trauma. The treatment of these fractures associated with neurological complications includes emergency decompression combined with reduction and stabilization of the fracture-dislocation. Usually, stabilization from L4 or L5 to the ilium combined with decompression of the spinal canal is advocated, thus fusing one or two additional healthy lumbar motion segments. We report on three patients with jumper's fractures, in whom we successfully performed a posterior decompression and open stabilization from S1 to the ilium, therefore sparing the motion segments L4/S1. Material and Methods3 patients (40, 45 and 49 years old) had been admitted to the emergency room after they attempted suicide and jumped from a greater height. All three had a jumper's fracture with fragments into the sacral canal and epidural hematoma. Indication for emergency decompression was present. In prone position a midline incision was performed and decompression of the sacral canal was achieved. After decompression bilateral long monoaxial USS II screws were placed into the ilium. Schanz’ screws from the USS fracture system were then introduced bilaterally in S1. The rods were rigidly mounted to the monoaxial ilium-screws. Fracture reduction and stabilization was performed under fluoroscopic control with the same maneuver as used for reduction of lumbar burst fractures. Fracture reduction and healing was examined with postoperative CT scan and controlled after 3 and 9 month. ResultsBony healing was achieved in all three patients. In all 3 cases implant removal was performed after bony healing was proved as seen in computed tomography. At 1 year follow-up, neurological exam was normal in 2 patients. 1 patient still had persistent incomplete bladder and bowel function disorders. All patients were able to walk without assistance. ConclusionIlio-sacral stabilization seems to be a reliable way of achieving reduction and bony healing in jumper's fractures. The reduction manoeuver is the same as described by Magerl and later on by Dick for lumbar burst fractures. As the lumbosacral motion segments (L4/5 and L5/S1) remain untouched, this technique offers the advantage of sparing important motion segments of the lumbar spine, thus being less invasive than the usually advocated techniques. However, this technique only is possible, if the segment L5/S1 is intact.