Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Treatment Outcomes in Vertical Shear Pelvic Fractures: A Comparative Study

Background Vertical shear (VS) pelvic ring injuries present a unique challenge due to their inherent vertical and rotational instability and the risk of massive bleeding. VS injuries may result from either bony or ligamentous injury. The goal in the treatment of VS fractures of the pelvis is to achieve and maintain an accurate reduction of the displaced hemipelvis. Aim of the study This study aimed to compare the results of the treatment of VS fractures pelvis by using iliosacral (IS) screws versus lumbopelvic fixation (LPF). Methodology This retrospective study was carried out on 40 patients with VS fracture pelvis injuries at El Hadara University Hospital, Alexandria, Egypt, from January 2020 to December 2020. Twenty of them were treated by an IS screw, and the other 20 were treated by LPF. Then, both groups were followed up for six months with regard to union rate, metal failure, and clinical outcomes. Results The EQ-5D showed a significant improvement in LPF more than the IS screw group in the five items of the score. Moreover, the total EQ-5D index showed a significant increase in the LPF group more than the IS screw group (p < 0.05). The incidence of neurological complication was found in four cases in the IS screw group, while no cases were found in the LPF group. The infection was found in six patients in the IS screw group and only three cases in the LPF group. The malunion was found in two cases in the IS screw group and no cases in the LPF group. The neurological change and the incidence of infection were significantly higher in the IS screw group than in the LPF group (p < 0.05). Conclusion Our results demonstrate reliable maintenance of reduction and acceptable complication rates with a minimally invasive LPF for VS fractured pelvis. The benefits of minimally invasive LPF may be offset by increased elective reoperations for the removal of instrumentation.

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.

Spinopelvic fixation for vertically unstable AO type C pelvic fractures and sacral fractures with spinopelvic dissociation- A systematic review and pooled analysis involving 479 patients

BACKGROUND

Posterior pelvic ring injuries can be fixed using iliosacral screws, plates or bars. Another promising modality is spinopelvic fixation or triangular osteosynthesis, indicated in vertical instability and sacral fractures associated with spinopelvic dissociation.

QUESTION/PURPOSE

This systematic review and pooled analysis was conducted to analyze the outcomes (functional and radiological) of the use of spinopelvic fixation, as well as assess the associated complications and neurological recovery.

METHODS

A systematic review of literature was performed from the PubMed/Medline, EMBASE and the SCOPUS databases. All studies reporting on spinopelvic fixations, with a minimum follow up of 1 year were included in the review. Pooled analysis was done for the outcome and complication rates. The MINORS Tool was used for assessing the risk of bias.

RESULTS

A total of 22 studies were included with average follow-up between 12 and 86.4 months. There were 7 prospective and 15 retrospective case series. The functional outcomes were excellent/good in 90% cases, across 8 studies (95% CI 84-95%); radiological outcomes were excellent/good in 97% cases (95% CI 94-100%) across 5 studies. The most commonly reported complications were hardware prominence in 21.3% (95% CI 11.6,30.9%) and infections in 7.2% cases (95% CI 4.8,9.5%). 73% of the patients reported partial or complete improvement in their neurological condition.

CONCLUSION

Spinopelvic fixation is an effective method in vertical instability of the pelvis and sacral fractures with spinopelvic dissociations, with good to excellent radiological and functional outcomes. However, adequate precautions are needed to avoid infections and wound complications.

Functional outcomes and quality of life after surgical treatment of spinopelvic dissociation: a case series with one-year follow-up

BACKGROUND

Spinopelvic dissociation is a transverse sacral fracture in conjunction with a vertical fracture of the sacrum on both sides, which causes the dissociation of the upper sacrum and spine from the pelvis. The most common causes of these fractures are high energy injuries such as falls from height or motor vehicle accidents. Spinopelvic dissociation is rare and heterogenous with severe associated injuries. The aim of this study was to assess the injury characteristics, changes in the quality of life and functional outcomes in the 1-year period after spinopelvic dissociation.

MATERIALS AND METHODS

During the period of 4 years (January 2016 and January 2020), 17 patients with spinopelvic dissociation were admitted to our centre and included in this single-centre prospective cohort study. One patient died during the admission; therefore 16 patients were enrolled in the analysis. Patients were followed-up for 12 months. The quality of life changes were evaluated via the SF-36 questionnaire, and the functional outcomes were evaluated using the Majeed pelvic score. Patients completed their questionnaires twice: firstly during hospitalization (regarding their pre-traumatic condition); and once again 1 year after their injury (regarding their current condition).

RESULTS

The mean age of the patients was 40.2 ± 17.7 years. Mean Majeed, PCS and MCS scores of SF-36 before the injury were 95.81 ± 9.50, 55.87 ± 8.89, and 43.76 ± 12.45, respectively. Mean Majeed, PCS and MCS scores 1 year after the injury were 71.13 ± 20.98, 43.45 ± 9.64, and 43.41 ± 7.56. During the period of 1 year after the injury, Majeed and PCS results reduced statistically significantly (P = 0.001 and P = 0.003, respectively), while MCS results remained similar (P = 0.501).

CONCLUSIONS

According to the data of our study, for patients with spinopelvic dissociation functional outcomes are significantly reduced and only one-third of the patients achieved pre-traumatic functional outcomes 1 year after the injury.