Spinopelvic dissociation: multidetector computed tomographic evaluation of fracture patterns and associated injuries at a single level 1 trauma center.

Abstract

The objective of the present study is to evaluate multidetector computed tomographic (MDCT) fracture patterns and associated injuries in patients with spinopelvic dissociation (SPD). Our institutional trauma registry database was reviewed from Jan. 1, 2006, to Sept. 30, 2012, specifically evaluating patients with sacral fractures. MDCT scans of patients with sacral fractures were reviewed to determine the presence of SPD. SPD cases were characterized into the following fracture patterns: U-shaped, Y-shaped, T-shaped, H-shaped, and burst. The following MDCT features were recorded: level of the horizontal fracture, location of vertical fracture, kyphosis between major fracture fragments, displacement of fracture fragment, narrowing of central spinal canal, narrowing of neural foramina, and extension into sacroiliac joints. Quantitative evaluation of the sacral fractures was performed in accordance with the consensus statement by the Spine Trauma Study Group. Medical records were reviewed to determine associated pelvic and non-pelvic fractures, bladder and bowel injuries, nerve injuries, and type of surgical intervention. Twenty-one patients had SPD, of whom 13 were men and eight were women. Mean age was 41.8years (range 18.8 to 87.7). Five fractures (24%) were U-shaped, six (29%) H-shaped, four (19%) Y-shaped, and six (29%) burst. Nine patients (43%) had central canal narrowing, and 19 (90%) had neural foramina narrowing. Eleven patients (52%) had kyphotic angulation between major fracture fragments, and seven patients (33%) had either anterior (24%) or posterior (10%) displacement of the proximal fracture fragment. Fourteen patients (67%) had associated pelvic fractures, and 20 (95%) had associated non-pelvic fractures. Two patients (10%) had associated urethral injuries, and one (5%) had an associated colon injury. Seven patients (33%) had associated nerve injuries. Six patients (29%) had surgical fixation while 15 (71%) were managed non-operatively. On trauma MDCT examinations, patients with SPD have characteristic fracture patterns. It is important to differentiate SPD from other pelvic ring injuries due to high rate of associated injuries. Although all SPD injuries are unstable and need fixation, the decision for operative management in an individual patient depends on the systemic injury pattern, specific fracture pattern, and the ability to attain stable screw fixation.