Treatment of unstable spinopelvic fractures: outcome of three surgical techniques—a retrospective single-center case series

Abstract

Purpose The aim of our retrospective study is to analyze how spinopelvic dissociations (SPDs) were treated in a single center trying to better understand how to improve surgical and non-surgical options. Methods Twenty patients of a single center surgically treated for SPDs between 2013 and 2021 were retrospectively included in this study. Three surgical techniques have been used: modified triangular stabilization, triangular stabilization and double iliac screws stabilization. Follow-up was assessed for up to 11.6 ± 9.9 months through ODI, MRS, NRS, IIEF or FSFI, a CT scan and whole spine X-ray examination. Results Twenty patients were admitted to our ER for traumatic spinopelvic dissociation. Surgical treatment for spinopelvic dissociation has been performed on average 11.5 ± 6.7 days after the trauma event. Eighteen fractures were C3 type and two C2 types. Neurological examination showed nerve root injury (N2) in 5 patients, incomplete spinal cord injury (N3) in 4 patients and cauda equina syndrome in two patients (N4). In case of neurologic deficits, routinary nerve decompression was performed. Three different surgical techniques have been used: 8 triangular fixations (Group 1), 6 modified triangular stabilization (Group 2) and 6 double iliac screws triangular fixation (Group 3). Conclusion In patients with post-traumatic neurological deficit, decompression surgery and fracture reduction seem to be associated with clinical improvement; however, sexual disorders seem to be less responsive to the treatment. Some open stabilization techniques, such as the double iliac screw, could help in restoring the sagittal balance in case of severe deformities.

Operative Technique for Sacral Insufficiency Fractures Causing Spinopelvic Dissociation

“…When deficits do arise, bowel/bladder dysfunction, lower extremity motor weakness, and lower extremity paresthesias can be observed. The presentation is typically similar to acute cauda equina syndrome with rates ranging from 20% to 100% 3,5,10,11 . Although there can be a role for nonoperative management of these fractures in rare instances, operative lumbopelvic fixation is almost always required to decrease pain, restore any lost alignment, prevent further malalignment, minimize the risk of neurological decline, and help return patients to preinjury ambulatory status.…”