Lumbopelvic fixation in the treatment of spinopelvic dissociation: union, complications, and neurologic outcomes of a multicenter case series

PURPOSE

To review outcomes of spinopelvic dissociation treated with open lumbopelvic fixation.

METHODS

We reviewed all cases of spinopelvic dissociation treated at three Level-I trauma centers with open lumbopelvic fixation, including those with adjunctive percutaneous fixation. We collected demographic data, associated injuries, pre- and postoperative neurologic status, pre- and postoperative kyphosis, and Roy-Camille classification. Outcomes included presence of union, reoperation rates, and complications involving hardware or wound.

RESULTS

From an initial cohort of 260 patients with spinopelvic dissociation, forty patients fulfilled inclusion criteria with a median follow-up of 351 days. Ten patients (25%) had a combination of percutaneous iliosacral and open lumbopelvic repair. Average pre- and postoperative kyphosis was 30 degrees and 26 degrees, respectively. Twenty patients (50%) had neurologic deficit preoperatively, and eight (20%) were unknown or unable to be assessed. All patients presenting with bowel or bladder dysfunction (n = 12) underwent laminectomy at time of surgery, with 3 patients (25%) having continued dysfunction at final follow-up. Surgical site infection occurred in four cases (10%) and wound complications in two (5%). All cases (100%) went on to union and five patients (13%) required hardware removal.

CONCLUSION

Open lumbopelvic fixation resulted in a high union rate in the treatment of spinopelvic dissociation. Approximately 1 in 6 patients had a wound complication, the majority of which were surgical site infections. Bowel and bladder dysfunction at presentation were common with the majority of cases resolving by final follow-up when spinopelvic dissociation had been treated with decompression and stable fixation.

Operating room efficiency of orthopedic surgery during the COVID-19 era

OBJECTIVE

The COVID-19 pandemic forced operating rooms (ORs) to adopt new safety protocols. Although these measures protected the health of patients and providers, their impact on OR efficiency remains unclear. Our objective was to further elucidate the effects of COVID-19 on orthopedic surgery OR efficiency.

STUDY DESIGN

This was a retrospective study of 14,856 orthopedic surgeries performed between December 1, 2019, and October 31, 2021.

METHODS

Institutional perioperative databases were used to identify relevant orthopedic surgeries. The onset of the COVID-19 period was set as March 12, 2020, when a state of emergency was declared in Tennessee. Both 90-day periods before and after this date were used for comparative analysis of the pre-COVID-19, peak-restrictions, and post-peak-restrictions time periods. Delay of first case start time and turnover time between cases were used as primary measures of efficiency.

RESULTS

There were 1853 pre-COVID-19 cases, 1299 peak-restrictions cases, and 11,704 post-peak-restrictions cases analyzed. Delay of first case start time was found to be significantly different among the time periods (mean [SD] minutes, 7 [14] vs 8 [18] vs 7 [17], respectively; P < .001). Turnover time between cases was also significantly different among the time periods (62 [49] vs 66 [51] vs 64 [51]; P = .002).

CONCLUSIONS

Although significant, there was minimal absolute change in orthopedic OR efficiency during the onset of the pandemic. These results suggest that the protocols enacted at our institution appropriately maintained orthopedic OR efficiency, even in the context of the rapidly increasing COVID-19 burden.

Percutaneous Posterior Pelvic Fixation of Spinopelvic Dissociation: A Multicenter Series of Displaced Patterns

OBJECTIVE

To characterize the success and complications of percutaneous posterior pelvic fixation in the treatment of displaced spinopelvic dissociation patterns.Design: Retrospective cohort study.Setting: Three Level I trauma centers.Patients: Fifty-three patients with displaced spinopelvic patterns.Intervention: Percutaneous iliosacral screw fixation.Main outcome measures: Incidence of union, fixation failure and soft tissue complications.

RESULTS

All patients had displaced, unstable patterns with a mean pre-operative kyphosis of 29.7 ± 15.4 degrees (range, 0-70). The majority of patients treated were neurologically intact (72%) or had an unknown exam at the time of fixation (15%). The median follow-up was 254 days (Interquartile range, 141-531).The union rate was 98%. Radiographic and clinical follow-up demonstrated one case (2%) of nonunion. Two patients (4%) had radiographic evidence of screw loosening at final follow-up, both of whom had fixation with a single sacroiliac style screw placed bilaterally and went on to uneventful union. Neurologic recovery occurred at an average of 195 ± 114 days (range, 82-363 days). When present, long-term neurologic sequelae most commonly consisted of radicular pain and paresthesias at final follow-up (n=3, 6%).

CONCLUSIONS

Percutaneous posterior pelvic fixation of select displaced spinopelvic dissociation appears to be safe with a low complication rate and reliable union. In a cohort of displaced fractures that were fixed in situ, we found a 2% rate of fixation failure/nonunion. While rare, radicular pain and paresthesias were the most common long-term neurologic sequela.

Neurologic injury after spinopelvic dissociation: Incidence, outcome, and predictors

BACKGROUND

Traumatic spinopelvic dissociation is a rare injury pattern resulting in discontinuity between the spine and bony pelvis. This injury is associated with a known risk of neurologic compromise which can impact the clinical outcome of these patients. We sought to determine incidence and characteristics of neurologic injury, outcomes following treatment, and predictive factors for neurologic recovery.

METHODS

We reviewed the clinical documentation and imaging of 270 patients with spinopelvic dissociation from three Level-1 trauma centers treated over a 20-year period. From this cohort, 137 patients fulfilled inclusion criteria with appropriate follow-up. Details surrounding patient presentation, incidence of neurologic injury, and outcome variables were collected for each injury. Neurologic injuries were categorized using the Gibbons criteria. Multivariate analysis was performed to assess for patient and injury factors predictive of neurologic injury and recovery.

RESULTS

The overall incidence of neurologic injury in spinopelvic dissociation injuries was 33% (45/137), with bowel and/or bladder dysfunction (n=16) being the most common presentation. Complete neurologic recovery was seen in 26 cases (58%) and two patients (4%) improved at least one Gibbon stage in clinical follow-up. The most common long-term neurologic sequela at final follow-up was radiculopathy (n=12, 9%). Increased kyphosis was found to be associated with neurologic injury (p=0.002), while location of transverse limb and Roy-Camille type were not predictive of neurologic injury (p=0.31 and p=0.07, respectively). There were no factors found to be predictive of neurologic recovery in this cohort.

CONCLUSION

Neurologic injury is commonly seen in patients with spinopelvic dissociation and complete neurologic recovery was seen in the majority of patients at final follow-up. When present, long term neurologic dysfunction is most commonly characterized by radiculopathy. While increasing kyphosis was shown to be associated with neurologic injury, no patient or injury factors were predictive of neurologic recovery.