Outcomes following Complex Combat-Related Lumbosacral Dissociation Injuries

Abstract

Introduction As war injury patterns have changed throughout Operations Iraqi and Enduring Freedom (OIF/OEF), a relative increase in the incidence of complex lumbosacral dissociation (LSD) injuries has been noted. LSD injuries are an anatomic separation of the spinal column from the pelvis, and represent a manifestation of severe, high energy trauma. We assessed the clinical outcomes of combat-related LSD injuries after operative treatment. Methods We performed a retrospective review of all patients surgically managed for complex LSD injuries since the beginning of current combat operations in the Middle East. Results A total of 20 patients met inclusion criteria and were treated as follows: posterior spinal fusion (12), sacroiliac screw fixation (7), and combined anterior–posterior fusion (1). The mean age was 28.2 years. The most common mechanism of injury was mounted improvised explosive device (IED, 50%). On average, 2.2 spinal regions were injured per patient. Neurologic dysfunction was present in four patients. Three patients underwent operative stabilization of their injuries before evacuation to the United States. Median time to surgery from injury was 12 days (range, 0–111 days). There was a 20% wound infection rate. Median follow-up was 45.5 months (range, 23.2–105.3 months), and one-third of all patients were medically retired because of their injuries. At most recent follow-up, 45% complained of chronic low back pain and 35% had persistent neurologic deficits; however, 30% were actively engaged in strenuous physical activities, including swimming, distance running, and training for special forces. Conclusion This is the largest series of operatively managed lumbosacral dissociation patients currently reported. Our series suggests that combat-related lumbosacral dissociation injuries frequently result in persistent, long-term neurologic dysfunction, disability, and chronic pain. Operative management carries a high postoperative risk of infection. However, two-thirds of patients were able to remain on active duty after their injuries, and two patients were able to complete marathon training.