Delayed Neurological Insufficiency Caused by Transverse Sacral Fracture After Minor Trauma in Elderly Patients  -Two Case Reports-

Lee, Jung‐Hoon; Kim, Jinuk; Jang, Jee-Soo; Lee, Sang-Ho

doi:10.2176/nmc.51.427

Cited by 7 publications

(4 citation statements)

References 13 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To sum up, in the literature we could not find a threshold timing of surgery that conclusively correlated with outcome [ 15 , 28 ]. But generally, a decompression within 48 h is considered the gold standard in the case of cauda equina syndrome [ 55 , 56 ], and no improvements in outcomes have been recorded in cases where decompression was performed during the initial 24-h window in comparison to the 48-h window [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Complete neurological deficits are exceptional. In general, neurological involvement associated with sacral insufficiency fractures resolves with the outcome of the fracture [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sacral insufficiency fractures can also result in neurological impairment, but little is known from the present literature about this kind of setting. Some authors suggest a possible role of sacral decompression in progressive neurological deficit associated with sacral insufficiency fractures, but with a lack of data supporting this strategy, the debate continues [ 8 , 55 , 56 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

Aprato,

Branca Vergano,

Casiraghi

et al. 2023

J Orthop Traumatol

View full text Add to dashboard Cite

Background There is no evidence in the current literature about the best treatment option in sacral fracture with or without neurological impairment. Materials and methods The Italian Pelvic Trauma Association (A.I.P.) decided to organize a consensus to define the best treatment for traumatic and insufficiency fractures according to neurological impairment. Results Consensus has been reached for the following statements: When complete neurological examination cannot be performed, pelvic X-rays, CT scan, hip and pelvis MRI, lumbosacral MRI, and lower extremities evoked potentials are useful. Lower extremities EMG should not be used in an acute setting; a patient with cauda equina syndrome associated with a sacral fracture represents an absolute indication for sacral reduction and the correct timing for reduction is “as early as possible”. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an indication for laminectomy after reduction in the case of a displaced sacral fracture in a high-energy trauma, while a worsening and progressive radicular neurological deficit represents an indication. In the case of a displaced sacral fracture and neurological deficit with imaging showing no evidence of nerve root compression, a laminectomy after reduction is not indicated. In a patient who was not initially investigated from a neurological point of view, if a clinical investigation conducted after 72 h identifies a neurological deficit in the presence of a displaced sacral fracture with nerve compression on MRI, a laminectomy after reduction may be indicated. In the case of an indication to perform a sacral decompression, a first attempt with closed reduction through external manoeuvres is not mandatory. Transcondylar traction does not represent a valid method for performing a closed decompression. Following a sacral decompression, a sacral fixation (e.g. sacroiliac screw, triangular osteosynthesis, lumbopelvic fixation) should be performed. An isolated and complete radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an absolute indication. A worsening and progressive radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. In the case of a displaced sacral fracture and neurological deficit in a low-energy trauma, sacral decompression followed by surgical fixation is indicated. Conclusions This consensus collects expert opinion about this topic and may guide the surgeon in choosing the best treatment for these patients. Level of Evidence: IV. Trial registration: not applicable (consensus paper).

show abstract

Section: Discussionmentioning

confidence: 99%

“…Complete neurological deficits are exceptional. In general, neurological involvement associated with sacral insufficiency fractures resolves with the outcome of the fracture [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

Aprato,

Branca Vergano,

Casiraghi

et al. 2023

J Orthop Traumatol

View full text Add to dashboard Cite

show abstract

“…SIF can be acute or insidious. As SIF signs and symptoms can mimic other degenerative disorders of the vertebra and hip, particularly in insidious cases, it can be underdiagnosed (Cheng, Herzog, & Lutz, ; Gotis‐Graham et al., ; Lee, Kim, Jang, & Lee, ; Longhino, Bonora, & Sansone, ). Although laboratory markers are usually unremarkable, it is crucial to determine the secondary causes of osteoporosis (Longhino et al., ).…”

Section: Consultationmentioning

confidence: 99%