P156. Update on percutaneous lumbopelvic fixation for unstable sacral fractures with spinopelvic dissociation patterns: two-year follow up

Abstract

BACKGROUND CONTEXT Sacral fractures with spinopelvic dissociation patterns (“H” or “U”-type sacral fractures) are highly unstable injuries that often require surgical treatment. In an effort to minimize surgical morbidity while achieving stable fixation, we modified the typical open surgical approach into a percutaneous lumbopelvic fixation technique. PURPOSE To report the outcomes and complications of a prospectively acquired consecutive case series of 19 patients with unstable sacral fractures with spinopelvic dissociation treated with percutaneous lumbopelvic fixation. STUDY DESIGN/SETTING Retrospective review of a prospectively acquired database. PATIENT SAMPLE Nineteen consecutive patients with unstable sacral fractures causing spinopelvic dissociation treated with percutaneous lumbopelvic fixation. OUTCOME MEASURES Blood loss, surgical time, fluoroscopy time, post-operative complications, Short Form Survery (SF-12v2), Oswestry Disability Index (ODI), and World Health Organization Wellbeing Index (WHO-5). METHODS Nineteen consecutive patients with unstable sacral fractures treated with percutaneous lumbopelvic fixation were prospectively enrolled into a database Intraoperative and postoperative data were reviewed, including blood loss, surgical time, fluoroscopy time and postoperative complications including infection. Postoperative follow-up included outcome measures including the Short Form Survey (SF-12v2), Oswestry Disability Index (ODI), and the World Health Organization Wellbeing Index (WHO-5). Screw accuracy, fracture reduction, fracture healing and implant integrity were evaluated on pre- and postoperative radiographs and CT scans. RESULTS Clinical follow-up in 19 patients who had surgery more than one year prior to this report averaged 2.1 years. Radiographic follow-up averaged 1.7 years. Operative time averaged 2 hours 25 minutes (105 – 215 minutes), fluoroscopy time averaged 141 seconds (68–225 seconds), and blood loss averaged 200 mL (75–400 mL). There was 1 deep wound infection. Postoperative CT scans in 17 patients showed a 3 mm lateral pedicle breach and a 2 mm iliac screw cortical breech (both asymptomatic) but otherwise accurate intraosseous pedicle screw (n=79) and iliac screw placement (n=37), for an overall accuracy of 98.3%. Sacral fracture kyphosis reduction was shown to be achievable. All but two patients maintained or regained full neurological function, and all patients healed their fractures. CONCLUSIONS Sacral fractures with spinopelvic dissociation patterns are severe injuries that have traditionally been treated with open lumbopelvic fixation, which is a surgery that carries substantial morbidity. Percutaneous techniques have been reported over the past several years. This is the largest case series, now with 2-year follow-up. Nineteen patients were treated with percutaneous lumbopelvic instrumentation with minimal blood loss and within a reasonable surgical duration, theoretically minimizing the physiological burden of surgery in these severely injured patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.