Neurological injury and patterns of sacral fractures

Abstract

To evaluate the morphological and neurological findings in sacral spine injuries, a retrospective study was conducted of all patients admitted to Erie County Medical Center over a 2-year period with the diagnosis of pelvic or sacral injury. Of these 253 patients, 44 were found to have sacral fractures and form the basis of this study. The type of fracture, neurological deficit, treatment, and outcome in these patients were analyzed. The patient population consisted of 25 males and 19 females, with a mean age of 34 years (range 15 to 80 years). The fractures were classified by the degree of involvement of the foramina and central canal. Fractures through the ala sacralis only (Zone I, 25 cases) or involving the foramina but not the central canal (Zone II, seven cases) were less likely to cause nerve injury (24% and 29%, respectively). Fractures involving the central canal (Zone III), both vertical (five cases) and transverse (seven cases), were more likely to cause neurological injury (60% and 57%, respectively). Neurological deficits in Zone I and II injuries were usually unilateral lumbar and sacral radiculopathies. Zone III deficits were usually bilateral and severe; bowel and/or bladder incontinence was present in six of the 12 patients in this group. Deficits generally improved with time; however, operative reduction and internal fixation may have been useful, particularly in patients with unilateral root symptoms. The treatment options are discussed, and previously published series of sacral fractures are reviewed. The authors conclude that the classification of sacral fractures described is useful in predicting the incidence and severity of neurological deficit.

Application triangular osteosynthesis for vertical unstable sacral fractures

“…In this series, and a high quality of fracture reduction was obtained, with the high excellent ratio of 90 % being achieved according to Matta criteria. Sacral plexus impairment was divided into four grades by Gibbons [2]. Nerve impairment always occurred in type II and III sacral fractures according to Denis classification, and was proposed to take nerve decompression [1].…”

“…Though triangular osteosynthesis fixed lumbosacral joint, the mobility of lower lumbar segments were destroyed [2]. Thus, it is necessary to select the fixed segment appropriately and to choose as short a segment as possible.…”

“…Sacral fractures often suffers from high-energy trauma: unstable sacral fractures occur in 17-30 % of patients with pelvic trauma [1,2], and this type fractures represent severe injuries, often associated with a high mortality and morbidity due to pain and malunion [3,4]. Non-operative treatment had been the first choice for these fractures historically, because of the lack of suitable technique and deficiency in implants.…”

Bildgebung des Plexus lumbosacralis

“…Die Unterscheidung zwischen sensiblen und motorischen Ausfällen und die klinischneurologische Erfassung der betroffenen Regionen und Muskulatur helfen dabei, die lädierten Nerven aufzusuchen und die Pathologie zu finden [12]. Das klinische Bild kann komplex sein durch eine Kombination von Muskelgruppenausfällen, sensorischen Veränderungen und (selten) Darm-und Blaseninkontinenz sowie sexueller Dysfunktion [9,24]. Eine lumbosakrale Plexopathie kann durch primäre Veränderungen der neuralen Strukturen selbst oder Kompression oder Infiltration von außen verursacht werden [27].…”

Anteriorly displaced transverse fractures of the sacrum in adolescents: report of two cases

“…The proponents of operative treatment believe that surgery permits decompression, open reduction and stabilization of the fracture [5,7,8,15]. Surgical reduction alone, or combined with decompressive laminectomy, may be found to have a positive effect, to some degree, on residual deficits, pain, and kyphotic deformity, in all patients followed over the long term.…”