Lumbopelvic Fixation for Sacral Insufficiency Fracture Presenting with Sphincter Dysfunction

Abstract

Sacral insufficiency fractures (SIFs) are common in the elderly. In patients with SIF, objective neurological abnormalities such as sphincter dysfunction or leg paresthesia are uncommon. We present a case of SIF accompanied by spinopelvic dissociation with late neurological compromise treated by spinopelvic fixation. A 61-year-old woman presented to our hospital with low back pain without obvious trauma history. She had a past history of eosinophilic granulomatosis with polyangiitis and treatment with steroids. Her low back pain became worse, and she started to have radiating left posterior thigh pain and motor weakness in the left ankle and both great toes with symptoms of stress urinary incontinence, constipation, and loss of anal sensation. Magnetic resonance imaging revealed an H-shaped sacrum fracture. We attributed the neurological symptoms to unstable SIF and performed lumbopelvic fixation. After the surgery, her leg pain and symptoms of stress urinary incontinence improved markedly, as did anal sensation. At a 6-month follow-up, the patient reported no low back pain and she was walking independently without pelvic complaints. CT showed bone union was achieved. Even minimally displaced SIF in patients with osteoporosis can be a cause of bowel and bladder disturbance. Lumbopelvic fixation is a treatment option for SIF with spinopelvic dissociation presenting neurological deficit.

Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator

“…Schmitz et al showed for the cement-augmented screw-rod system good postoperative mobility in 10 out of 15 patients but had surgical complications in 5 out 15 patients [ 11 ]. For lumbopelvic fixation, there is only one case report reporting good clinical outcome [ 12 ] and compared to the other techniques it is more invasive. Percutaneous screw stabilization is often used for osteoporotic fractures, because they can be implanted minimally invasive and ensure early mobilisation at low perioperative risk.…”

Acute Neurological Deficit Due to Sacral Insufficiency Fracture With Coexistent Severe Lumbar Canal Stenosis: A Case Report

“…Considering this as a form of unstable spinopelvic dissociation, the authors performed L3 to S1 lumbopelvic fixation. The patient had full recovery at 6 months [13]. Attempts to classify SIF and guide management according to classification have been recently made [2,17].…”

“…Neurological involvement in SIF is rare, with an incidence of 2.8% reported [6,7]. Objective signs of neurological involvement may include sphincter disturbance, motor weakness, or leg paraesthesia [13]. While conservative management of SIF generally has satisfactory outcomes, management in the setting of neurological involvement and coexisting spinal pathology—particularly in elderly patients—is controversial.…”

Sacral insufficiency fractures – a commonl y overlooked cause of low back and pelvic pain; a case report and literature review

“…iliosacral screw fixation ((iss) is a commonly used treatment method, but some studies have shown that through this method satisfactory mechanical stability is not achieved, which leads to displacement and instability of the screws (39). lumbosacral fixation technique is indicated in patients with neurological complications due to unstable sacral fractures (40).…”

“…iliosakralna fiksacija vijcima često je upotrebljavana metoda liječenja, no neka su istraživanja pokazala da se ovom metodom ne postiže zadovoljavajuća mehanička stabilnost, što dovodi do pomicanja i nestabilnosti vijaka (39). lum bosakralna fiksacija indicirana je u bolesnika s neurološkim komplikacijama zbog nestabilnog prijeloma sakruma (40).…”