Is Sacral Dysmorphism Protective Against Spinopelvic Dissociation? Multicenter Case Series

Traumatic lumbosacral instability: part 1 - proposing a definition and identifying underlying injury patterns

Traumatic lumbosacral instability (TLSI) generally refers to a traumatic disruption of the lumbopelvic junction. The ambiguous use of this term has contributed to confusion and limited understanding of injuries that can impact lumbosacral stability. As of now, TLSI lacks a clear definition, and the underlying injury patterns remain inadequately characterized. Therefore, the objectives of the first part of this two-part series are: (1) to establish a precise definition of TLSI, (2) to identify and systematically characterize the injury patterns underlying TLSI, and (3) to outline principles for diagnosing and classifying these underlying conditions.

[Translated article] Spinopelvic dissociation: Current concepts

INTRODUCTION

Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited.

OBJECTIVE

To analyze the treatment indications based in classifications and surgery techniques.

METHOD

A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID.

CONCLUSIONS

The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.

Spinopelvic dissociation: Current concepts

INTRODUCTION

Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited.

OBJECTIVE

To analyze the treatment indications based in classifications and surgery techniques.

METHOD

A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID.

CONCLUSIONS

The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.

Operative outcomes and fracture patterns in dysmorphic sacrums

INTRODUCTION

Sacral dysmorphism has been previously reported to occur in 30 % to 40 % of adult patients. It has been described by 6 widely accepted parameters on outlet x-ray views of the pelvis: steep alar slope, retained S1-S2 disk, presence of mamillary bodies, sacralized L5, tongue in groove SI joint, and non-round neural foramina. Studies have focused on the importance of identifying dysmorphism for safe treatment of fractures in pelvises with dysmorphic upper sacral segments. Less is known regarding whether dysmorphism may be protective against trauma. To our knowledge no studies have focused on how dysmorphic sacrums fracture compared to non-dysmorphic (ND) sacrums, and whether operative rates are different.

AIMS

To assess the rate of operative fixation of sacral fractures between pelvises with dysmorphic and ND sacrums, as well as whether a difference exists in fracture morphology between groups.

DESIGN/METHODS

This is a retrospective cohort study out of a single level 1 trauma center. Study participants consisted of those sustaining a pelvic ring injury who were 18 years or older in which orthopaedics was consulted, had CT imaging available, and did not have isolated acetabulum fractures. 355 subjects were included of 671 reviewed pelvic ring injuries. Sacrums were deemed dysmorphic if they met at least one of the six dysmorphic features, and it was determined whether they underwent operative intervention. Fracture classifications and patterning were identified on CT imaging. P values were set <0.05.

RESULTS

We found that 44 % of inclusions had a dysmorphic sacrum with the most common feature to be a steep alar slope (68 %). 17.17 % of subjects with a ND sacrum underwent treatment versus 16.56 % for dysmorphic sacrums. No statistical difference regarding operative fixation rates was uncovered (p = .879). However, we found a difference in fracture patterns regarding ipsilateral posterior SI joint widening (p = 0.020).

CONCLUSION

Our study suggests that sacral dysmorphism is not protective against operative fixation based on no difference in operative rates between groups. However, our data supports that pelvises with dysmorphic sacrums may fracture differently based on the difference observed regarding other pelvic ring injuries.