Sacral decompression and lumbopelvic fixation for patients with high-level sacral fracture-dislocation

Abstract

Objective To evaluate the clinical outcomes of sacral decompression and lumbopelvic fixation for neurologically impaired patients with sacral fracture-dislocation. Methods From January 2009 to December 2013, 32 patients with sacral fracture and spino-pelvic dissociation of Roy-Camille types Ⅱ and Ⅲ were treated at our department. They were 21 men and 11 women, with a mean age of 34.3 years. According to Roy-Camille classification, 9 patients belonged to type Ⅱ and 23 to type Ⅲ; 25 patients had S1 fracture-dislocation and 7 S2 fracture-dislocation. After their overall conditions were stabilized, all were treated with open reduction, sacral decompression and lumbopelvic fixation. Pre- and post-operative neuro-logical functions were recorded by Gibbons criteria. We analyzed the correlations between the neurological recovery and (i) the extent of cauda equina deficit and (ii) the continuity of sacral roots, as well as the correlations between the functional recovery of the bladder and bowels and the above two. The reduction and fusion status were evaluated by the Mears and Velyvis radiological criteria; clinical effectiveness was evaluated by Majeed scoring system. Intra- and post-operative complications were all recorded. Results The mean follow-up time for this series was 35 months (from 25 to 47 months). The average Gibbons score improved from 4.0 to 2.7 at the follow-ups. The patients with mild cauda equina deficit or with continuity of sacral roots achieved significantly better neurological recovery than those with severe cauda equina deficit or with discon-tinuity of sacral roots (P< 0.001). However, the functional recovery of the bladder or bowels was not significantly correlated with the extent of cauda equina deficit or with the continuity of sacral roots. Anatomical reduction was achieved in 26 patients, satisfactory reduction in 5 and unsatisfactory reduction in one, yielding a satisfaction rate of 96.9%. Bony fusion was obtained in 29 patients at 3 months, but not until at 9 months in 2 patients, and still not at 9 months in one who showed no symptoms. The Majeed scoring showed 22 excellent, 6 good and 4 moderate cases, giving an excellent to good rate of 87.5%. Two patients developed deep wound infection, 3 complained of the pain related to hardware prominence, and one had unilateral rod breakage. Conclusions In treatment of sacral fracture with spino-pelvic dissociation, sacral decom-pression and lumbopelvic fixation can lead to effective neurological recovery, restoration of lumboscacral sta-bility and alignment, early ambulation and prevention of deformity. Complete neurological recovery is more likely in patients with incomplete cauda equina deficit or with continuity of all sacral roots. Key words: Sacrum; Fractures,bone; Dislocation; Fracture fixation, internal; Sacral decompression