U-type bilateral sacral fracture with spino-pelvic dissociation caused by epileptic seizure

Tailored sacroplasty for sacral fracture secondary to an epileptic seizure

Background

Sacral fractures causing neurological deficits secondary to epileptic seizures are very rare. They are traditionally treated by laminectomy and sacral fixation. However, minimally invasive techniques such as sacroplasty offer more limited surgery with decreased morbidity. Here, a 23-year-old male with a seizure-induced sacral fracture was successfully treated with a decompressive laminectomy and transcorporal sacroplasty.

Methods

After a grand-mal seizure, a 23-year-old male presented with severe paraparesis accompanied by bilateral S1/S2 radiculopathy and urinary/fecal incontinence (Gibbons grade 4). When studies documented a Roy-Camille type 2 sacral fracture with severe central compression of the S1/S2 spinal canal, he underwent an S1-S2 laminectomy with transcorporal sacroplasty.

Results

On the 1st postoperative day, he ambulated without assistance and demonstrated only mild residual sensory deficits (Gibbons grade 2); 1-month later, he walked without assistance.

Conclusion

A 23-year-old male with a seizure-induced sacral fracture was successfully treated with a decompressive S1/S2 laminectomy/transcorporal sacroplasty.

Management of a rare case of isolated U-shaped displaced sacral fracture in a young female high school student

Sacral fractures in young healthy patients are usually linked to high-energy trauma. They are often associated with multiple other injuries. Isolated sacral fractures are rare and can be easily missed in the absence of other surrounding pelvic or spinal injuries. In this article, we present a rare case of isolated U-shaped displaced sacral fracture despite the high-energy mechanism of injury being missed on initial presentation. This is a 17-year-old healthy female who presented to the emergency department after falling from five-meter height. She complained of lower back pain and inability to ambulate. Physical examination revealed significant sacral tenderness, bilateral lower limb weakness and hypoesthesia, anesthesia of the saddle area, weak anal tone and absent anal reflex. Initial radiographs showed no apparent fractures. Further imaging by pelvic computed tomography, however, revealed an isolated U-shaped displaced sacral fracture. The patient was treated by decompression and lumbopelvic fixation by triangular osteosynthesis and iliosacral screw. This fixation method restored stability of the spinopelvic junction and allowed for early mobilization. At her 18-month follow-up visit, she showed minimal disability score (10%) on the Oswestry Disability Index. In conclusion, sacral fractures are considered exceedingly rare to occur in isolation and in young healthy patients.

Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures: Surgical Management and Early Outcome

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or (and) sacral decompression. EQ-5d score was applied to evaluate the patients' quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years (range: 15-55 years) at the time of injury. There were 6 females and 9 males. The mean followup time was 22.7 months (range: 9 47 months) and mean full weight-bearing time was 9.9 weeks (range: 8-14 weeks). Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle (mean 27.87°, and range: 8°-90°) of the sacrum was smaller than that pre-operation (mean 35.67; range: 15-90) with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score (VAS) was reduced from preoperative 7.07 (range: 5-9) to postoperetive 1.93 (range: 1-3). All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work foil time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.