Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When spinopelvic dissociation is expediently identified and treated appropriately, patient outcomes can be maximized, highlighting the importance of early diagnosis and treatment. Because of its rarity and complexity, there remains a paucity of high-level evidence-based guidance on treating this complex issue. No consensus exists on fixation techniques or reduction maneuvers to achieve stability, allowing for early functional rehabilitation. The purpose of this article is to review the current body of literature to better understand this injury pattern to help establish a treatment algorithm that appropriately guides the treating surgeons in the surgical planning and perioperative care of these patients.
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http://dx.doi.org/10.5435/JAAOS-D-19-00863 | DOI Listing |
Arch Orthop Trauma Surg
December 2024
Harborview Medical Center, University of Washington School of Medicine, Seattle, Seattle, USA.
Traumatic lumbosacral instability (TLSI) generally refers to a traumatic disruption of the lumbopelvic junction. The ambiguous use of this term has contributed to confusion and limited understanding of injuries that can impact lumbosacral stability. As of now, TLSI lacks a clear definition, and the underlying injury patterns remain inadequately characterized.
View Article and Find Full Text PDFJ Orthop Trauma
November 2024
Department of Orthopaedic Surgery, UC Davis, Sacramento, CA.
Objectives: The purpose of this study was to evaluate the biomechanical stability of a modified triangular osteosynthesis construct with S1 pedicle screws compared with other described lumbopelvic fixation constructs in a U-type sacral fracture model.
Methods: U-type sacral fractures were created in validated fourth-generation spinopelvic models. Four different constructs were cyclically loaded with displacement measured in all planes: (1) bilateral L5 pedicle screws with rods attached to iliac bolts, (2) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts, (3) bilateral L5 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw, and (4) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw.
Cureus
September 2024
Orthopaedics, Centro Hospitalar São João, Porto, PRT.
In this article, we aim to present the case of a five-year-old child with traumatic spondylolisthesis of L5-S1 associated with a sacral fracture, manifesting as a spinopelvic dissociation. The goal of surgical treatment is to reduce the deformity and provide posterior fixation to restore the sagittal alignment of the lumbosacral junction. One-year follow-up showed good clinical and radiological outcomes.
View Article and Find Full Text PDFBr J Neurosurg
May 2024
Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Background: Sacropelvic fractures with multidirectional instability require complex reduction and stabilisation techniques. Triangular osteosynthesis reconstruction is an established technique but hardware failure rates remain high and screw trajectories unfamiliar to spine surgeons. Our technique allows de-rotation of the pelvis, fracture reduction in both vertical and transverse planes, immediate weight bearing and is more reproducible for complex spine surgeons.
View Article and Find Full Text PDFEur J Orthop Surg Traumatol
July 2024
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN, 37232, USA.
Purpose: To review outcomes of spinopelvic dissociation treated with open lumbopelvic fixation.
Methods: We reviewed all cases of spinopelvic dissociation treated at three Level-I trauma centers with open lumbopelvic fixation, including those with adjunctive percutaneous fixation. We collected demographic data, associated injuries, pre- and postoperative neurologic status, pre- and postoperative kyphosis, and Roy-Camille classification.
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