Sacral Fracture with Neurodeficit – Is Laid-Back Approach a Passe?

Abstract

Management of sacral fractures with neurological deficits has been a topic of debate. Literature is divided between conservative and operative management. We report a case of a 32-year-old male with post-traumatic unstable complex transverse sacrum fracture and associated stable pelvic ring fractures with loss of bowel and bladder control. He had a fall from the second floor over the buttocks. Plain lateral radiography showed a transverse sacral fracture located between S2 and S3 with kyphosis at the fracture site. MRI showed a compromised canal due to a large retro pulsed fragment pressing over the anterior aspect of sacral roots. Thorough decompression of cauda equina and sacral roots was performed, and sacral ala fracture was fixed with two percutaneous 6.5 mm cannulated cancellous Ilio-sacral screws and two 3.5 mm recon locking plates were applied for the sacrum. The patient regained his bladder control 3 months after the surgery and bowel control 4 months after the surgery. At the end of 1 year, the patient has persistent saddle anaesthesia but good bowel and bladder control. Early decompression and stabilization of unstable complex sacrum fractures with neurological compromise can facilitate optimum neurological improvement and favourable clinical outcomes in terms of early mobilization and pain relief. Keywords: Fracture, Sacrum, Decompression surgery