Functional outcomes and quality of life after surgical treatment of spinopelvic dissociation: a case series with one-year follow-up

Abstract

Background Spinopelvic dissociation is a transverse sacral fracture in conjunction with a vertical fracture of the sacrum on both sides, which causes the dissociation of the upper sacrum and spine from the pelvis. The most common causes of these fractures are high energy injuries such as falls from height or motor vehicle accidents. Spinopelvic dissociation is rare and heterogenous with severe associated injuries. The aim of this study was to assess the injury characteristics, changes in the quality of life and functional outcomes in the 1-year period after spinopelvic dissociation. Materials and methods During the period of 4 years (January 2016 and January 2020), 17 patients with spinopelvic dissociation were admitted to our centre and included in this single-centre prospective cohort study. One patient died during the admission; therefore 16 patients were enrolled in the analysis. Patients were followed-up for 12 months. The quality of life changes were evaluated via the SF-36 questionnaire, and the functional outcomes were evaluated using the Majeed pelvic score. Patients completed their questionnaires twice: firstly during hospitalization (regarding their pre-traumatic condition); and once again 1 year after their injury (regarding their current condition). Results The mean age of the patients was 40.2 ± 17.7 years. Mean Majeed, PCS and MCS scores of SF-36 before the injury were 95.81 ± 9.50, 55.87 ± 8.89, and 43.76 ± 12.45, respectively. Mean Majeed, PCS and MCS scores 1 year after the injury were 71.13 ± 20.98, 43.45 ± 9.64, and 43.41 ± 7.56. During the period of 1 year after the injury, Majeed and PCS results reduced statistically significantly (P = 0.001 and P = 0.003, respectively), while MCS results remained similar (P = 0.501). Conclusions According to the data of our study, for patients with spinopelvic dissociation functional outcomes are significantly reduced and only one-third of the patients achieved pre-traumatic functional outcomes 1 year after the injury.

Recent Progress in the Classification and Operation of Sacral Fractures

“…Spinopelvic fixation also has its disadvantages. Petryla et al [ 36 ] followed up 16 patients with pelvic and spinal separation in a single center for 1 year and pointed out that only one-third of patients with pelvic and spinal separation reached the preinjury level one year after injury. Spinopelopexy has been continuously improved since it was shown to provide good reduction and sufficient strength for bilateral sacral fractures with vertical instability.…”

Functional Outcomes and Quality of Life After Sacrum Fractures Managed by Either Operative or Conservative Approaches: A Case Series With One-Year Follow-Up

“…Pelvic fractures caused by high-energy trauma, such as motor vehicle accidents or falls from a considerable height, commonly lead to sacral fractures. Detecting and treating sacral fractures require a high degree of suspicion and clinical judgment for precise diagnosis and management [ 1 ]. Fractures are present in 30% to 45% of pelvic ring injuries, stemming from a range of causes, such as high-energy trauma to low-energy falls in osteoporotic individuals.…”

Treatment of Unstable Sacral Fractures with Robotically‐aided Minimally Invasive Triangular Fixation

“…These types of fractures invariably result from high-energy injuries and have severe complications. 1,2 Currently, most surgeons advocate for surgical treatment in treating unstable sacral fractures rather than conservative management, with the main goals of such an operation being: to obtain anatomical reduction and stable fixation so that the fracture healing rate can be increased; to reconstruct the normal weight-bearing load and the early ambulation can be ensured; to repair nerve damage caused by progressive fracture deformity and to alleviate the pain caused by instability of the lumbosacral junction. [1][2][3][4] Triangular fixation (TFX) is a classical type of internal fixation for the treatment of unstable sacral fractures.…”

“…1,2 Currently, most surgeons advocate for surgical treatment in treating unstable sacral fractures rather than conservative management, with the main goals of such an operation being: to obtain anatomical reduction and stable fixation so that the fracture healing rate can be increased; to reconstruct the normal weight-bearing load and the early ambulation can be ensured; to repair nerve damage caused by progressive fracture deformity and to alleviate the pain caused by instability of the lumbosacral junction. [1][2][3][4] Triangular fixation (TFX) is a classical type of internal fixation for the treatment of unstable sacral fractures. TFX consists of unilateral or bilateral lumbopelvic fixations and iliosacral screws, and has been widely used for its superior usefulness as a biomechanical model, fixed strength, and ability to improve neurological deficiency.…”