Abstract
Introduction Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. Recent technological advances have allowed for percutaneous fixation with indirect reduction. Herein, we evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Methods Retrospective review of patients undergoing spinopelvic fixation from a single, level one trauma center from 2012 to 2017. Patient information regarding demographics, associated injuries, and treatment outcome measures was recorded and analyzed. All fractures were classified via the AO Spine classification system. Results Thirty-one spinopelvic dissociations were identified: 15 treated with open and 16 with percutaneous techniques. The two treatment groups had similar preoperative characteristics including spinopelvic parameters (pelvic incidence and lumbar lordosis). Compared to open reduction internal fixation, percutaneous fixation of spinopelvic dissociation resulted in statistically significantly lower blood loss (171 cc versus 538 cc; p = 0.0013). There were no significant differences in surgical site infections (p = 0.48) or operating room time (p = 0.66). Conclusion Percutaneous fixation of spinopelvic dissociation is associated with significantly less blood loss. Treatment outcomes in terms of infection, length of stay, operative cost, and final alignment between the open and percutaneous group were similar.
Highlights
Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy
We hypothesized that percutaneous fixation of spinopelvic dissociation using minimally invasive fusion from lumbar four or five to pelvis would result in shorter operative time, fewer postoperative transfusions, and decreased estimated blood loss while adequately reestablishing spinopelvic parameters
The cohort consisted of patients treated with open reduction and lumbopelvic fixation and with indirect reduction and percutaneous lumbopelvic fixation
Summary
Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. We evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Traditional treatment methods involving open reduction with internal fixation have been observed to have high rates of postoperative infections up to 14–16% [7,8,9,10]. We critically evaluate results of spinopelvic dissociations treated with either percutaneous or open reduction. To our knowledge, this is the largest series of patients with spinopelvic dissociation treated surgically. We hypothesized that percutaneous fixation of spinopelvic dissociation using minimally invasive fusion from lumbar four or five to pelvis would result in shorter operative time, fewer postoperative transfusions, and decreased estimated blood loss while adequately reestablishing spinopelvic parameters
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