Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Abstract

The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

Lumbo-Pelvic Dissociation in a Patient With Complex Spinal Deformity: A Case Report

“…Traumatic lumbopelvic dissociation is an extremely rare injury that accounts for ~1% of all spinal fractures and is always the result of high-energy trauma [ 3 ]. Due to the high energy of these traumatic events, concomitant injuries are extremely common and there are extremely high rates of neurological deficits and infection as seen in our case report [ 10 , 11 , 13 ]. The optimal treatment of these injuries has not been well described and usually depends on surgeon preference as well as ability [ 4 , 7 ].…”

“…The optimal treatment of these injuries has not been well described and usually depends on surgeon preference as well as ability [ 4 , 7 ]. Despite the findings that function, sacral slope, and subjective feelings of pain all improve, patients treated with lumbopelvic fixation still suffer from some level of impairment at follow-up [ 11 ].…”

“…The operative intervention has been associated with earlier mobilization and better mechanical stability acutely. However, there is a relatively high infection rate as could be expected due to the soft tissue damage [2][3][4]8,9,[10][11][12]. There is at least one case treated conservatively with late fixation reporting a favorable clinical outcome [1].…”

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

“…There are few studies, with small cohorts, that have reported on the quality of life and functional outcomes of patients after spinopelvic dissociation [ 11 – 13 ]. This indicates that spinopelvic dissociation is a rare injury.…”