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

Published:October 27, 2022DOI:https://doi.org/10.1016/j.injury.2022.10.008

      Highlights

      • Evaluating incidence and outcome predictors for neurologic injury in spinopelvic dissociation.
      • Increasing kyphosis is associated with incidence of neurologic injury.
      • Complete recovery from neurologic injury occurs in over half of all patients, with radiculopathy being the most common long-term sequelae.

      Abstract

      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.

      Keywords

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      References

        • Sullivan MP
        • Smith HE
        • Schuster JM
        • Donegan D
        • Mehta S
        • Spondylopelvic Dissociation Ahn J.
        Orthop Clin North Am. 2014; 45: 65-75
        • Yi C
        • Hak DJ.
        Traumatic spinopelvic dissociation or U-shaped sacral fracture: A review of the literature.
        Injury. 2012; 43: 402-408
        • Nork SE
        • Jones CB
        • Harding SP
        • Mirza SK
        • Routt Jr MC
        Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results.
        J Orthop Trauma. 2001; 15: 238-246
        • Bäcker HC
        • Vosseller JT
        • Deml MC
        • Perka C
        • Putzier M.
        Spinopelvic dissociation: a systematic review and meta-analysis.
        JAAOS. 2021; 29: e198-e207
        • Kempen DHR
        • Delawi D
        • Altena MC
        • Kruyt MC
        • van den Bekerom MPJ
        • Oner FC
        • et al.
        Neurological outcome after traumatic transverse sacral fractures: a systematic review of 521 patients reported in the literature.
        JBJS Reviews. 2018; 6: e1
        • Roy-Camille R
        • Saillant G
        • Gagna G
        • Mazel C.
        Transverse fracture of the upper sacrum: suicidal Jumper's Fracture.
        Spine. 1985; 10
        • Lehman RA
        • Kang DG
        • Bellabarba C
        A new classification for complex lumbosacral injuries.
        Spine J. 2012; 12 (Jr.): 612-628
        • Denis F
        • Davis S
        • Comfort T.
        Sacral fractures: an important problem. Retrospective analysis of 236 cases.
        Clin Orthop Relat Res. 1988; 227: 67-81
        • Kokubo Y
        • Oki H
        • Sugita D
        • Takeno K
        • Miyazaki T
        • Negoro K
        • et al.
        Functional outcome of patients with unstable pelvic ring fracture:Comparison of short- and long-term prognostic factors.
        J. Orthopaedic Surgery. 2017; 252309499016684322
        • Lindahl J
        • Mäkinen TJ
        • Koskinen SK
        • Söderlund T.
        Factors associated with outcome of spinopelvic dissociation treated with lumbopelvic fixation.
        Injury. 2014; 45: 1914-1920
        • Petryla G
        • Bobina R
        • Uvarovas V
        • Kurtinaitis J
        • Sveikata T
        • Ryliskis S
        • et al.
        Functional outcomes and quality of life after surgical treatment of spinopelvic dissociation: a case series with one-year follow-up.
        BMC Musculoskeletal Disorders. 2021; 22: 795
        • Kepler CK
        • Schroeder GD
        • Hollern DA
        • Chapman J
        • Fehlings M
        • Dvorak M
        • et al.
        Do formal laminectomy and timing of decompression for patients with sacral fracture and neurologic deficit affect outcome?.
        J Orthop Trauma. 2017; 31: S75-S80
        • Yilmaz E
        • Hoffmann MF
        • von Glinski A
        • Kruppa C
        • Hamsen U
        • Schmidt CK
        • et al.
        Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation.
        Sci Rep. 2020; 10: 14878
        • Yao YC
        • Lin HH
        • Chou PH
        • Wang ST
        • Liu CL
        • Chang MC.
        Risk factors for residual neurologic deficits after surgical treatment for epidural abscess in the thoracic or lumbar spine.
        Spine J. 2020; 20: 1638-1645
        • Nachef N
        • Bariatinsky V
        • Sulimovic S
        • Fontaine C
        • Chantelot C.
        Predictors of radial nerve palsy recovery in humeral shaft fractures: A retrospective review of 17 patients.
        Orthop Traumatol Surg Res. 2017; 103: 177-182
        • Mermans JF
        • Franssen BB
        • Serroyen J
        • Van der Hulst RR.
        Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair.
        Hand (N Y). 2012; 7: 233-241