Spinopelvic Dissociation: A Retrospective Case Study and Review of Treatment Controversies

Abstract

Spinopelvic dissociation represents a heterogeneous group of injuries often in the context of polytraumatized patients with other injuries. Our closed reduction and fixation technique resulted in satisfactory outcomes. We present a treatment algorithm for these rare injuries.

Letter to the Editor: Spinopelvic Dissociation: A Systematic Review and Meta-analysis

“…The complications associated with a posterior approach, highlighted well in this review, have also driven our formulation of an amended algorithm. Similar to the findings of previous series, 2,4-6 we have found consistent and uncomplicated union using iliosacral and/or transiliac-transsacral screw fixation for these injuries, even in the setting of displacement and kyphosis. If a patient has reasonable sagittal alignment and is neurologically intact and osseous fixation pathways exist for iliosacral and transiliac-transsacral screw fixation, the trauma team will assume management and treat the patient using percutaneous fixation of the posterior pelvis.…”

“…Based on the existing literature, the importance of sagittal plane reduction in displaced fractures is not clear. 4,7,8 We have found the most clinically relevant sequelae of residual kyphosis and displacement to be neuroforaminal narrowing as opposed to symptoms secondary to altered spinopelvic parameters. Postoperative radiculopathy, particularly at the S1 level, is not uncommon in these patients and can take months to improve.…”

Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

“…LPF To evaluate the clinical outcomes of traumatic spino‐pelvic dissociation (TSD) treated with modified bilateral triangular fixation rca n = 18 14m/4f Falling: 16 mva: 2 all sacral fractures had associated injuries U‐shaped fractures: 10 H‐shaped fractures: 6 Y‐shaped fractures: 2 Roy–Camille classification: type II: 12 type III: 6 sacral plexus decompression: 6 cases n/a Futamura et al (2018)/ International Orthoaedics 38 mod. LPF To describe the procedure and outcomes of a new approach, which we refer to as “within ring”-based sacroiliac rod fixation (SIRF) rca n = 15 10m/5f Fall:7 mva: 5 Compression by a heavy item:3 AO/OTA class: 61-B2.3: 1 C1.3: 4 C2.3: 7 C3.3: 1 H-type spinopelvic dissociation: 2 16.9 (9–30) Chou et al (2018)/Journal of the American Academy of Orthopaedic Surgeons 39 MIS-LPF To present a series of spinopelvic dissociation cases from a level I trauma center rca n = 18 n/a None of the patients underwent open spinal surgical decompression n/a Abo-Elsoud et al (2018)/Journal of Orhtopaedic Trauma 40 mod.LPF To preset a modified biplanar posterior pelvic fixation technique in patients with unstable sacral fractures rca n = 16 9m/7f Patients with unilateral vertical sacral fractures showing fracture comminution, gaps, vertical instability, and/or disruption of the L5/S1 facet joint n/a Shah et al (2019)/Cureus 41 MIS-LPF To analyze the outcome and complications of patients who underwent minimally invasive lumbopelvic fixation to treat unstable U-type sacral fractures rca n = 10 n/a Adult patients with U-type or vertical shear fra...…”

Traumatic sacralization of L5 vertebra with severe extension type spinopelvic dissociation: A case report

“…The fractures were classified as type III and VI as per Roy's classification, with all of the patients experiencing severe neurological deficit; only two patients had definitive management with spinopelvic fixation. Taking in account the rare form of injury, in 2018, Chou and his colleagues [ 5 ] reviewed retrospectively 18 reported cases in the literature. They were able to formulate an algorithm for managing spinopelvic dissociation based on Roy's classification; however, the authors of each individual report had different surgical techniques in terms of reduction, implant, and decompression.…”