Displaced spinopelvic dissociation with sacral cauda equina syndrome: outcome of surgical decompression with a preliminary management algorithm

• Published in: European spine journal Vol. 21; no. 9; pp. 1815 - 1825
• Main Author: Ayoub, Mostafa A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2012; Springer Nature B.V
• Subjects: Adult; Age; Algorithms; Bone Screws; Cauda Equina Syndrome; Classification; Decompression; Decompression, Surgical - methods; Female; Fracture Fixation, Internal - methods; Fractures; Humans; Injuries; Joints; Kyphosis; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original; Original Article; Pelvis; Pelvis - surgery; Polyradiculopathy - etiology; Polyradiculopathy - surgery; Retrospective Studies; Sacrum; Sacrum - injuries; Sacrum - surgery; Spinal cord; Spinal Fractures - complications; Spinal Fractures - surgery; Spinal Fusion - methods; Spine; Surgical Orthopedics; Treatment Outcome; Young Adult; ‘U-shaped’ sacral fractures; Cauda equina syndrome; Spinopelvic dissociation; Lumbopelvic fixation; Surgical decompression
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-012-2406-9

Introduction Displaced spinopelvic dissociation with cauda equina syndrome is still unclear challenging problem with multiple instabilities. This retrospective study tried to evaluate and analyze the results of surgical decompression and lumbopelvic fixation of these injuries. Methods Twenty-eight polytrauma patients with displaced spinopelvic dissociation and cauda equina syndrome were included. Preoperatively, they had thorough clinical, neurological, and radiological evaluation and classification. Operatively, they underwent primary, secondary, or tertiary decompression then spinopelvic fixation. Postoperatively, they were followed up for an average of 26 months. Hannover pelvic scoring system was applied for outcome evaluation. Results The mean age was 33.7 years; 17 cases were males and 11 were females. According to Roy-Camille, 13 cases had type II and 15 cases had type III injuries; cauda equina syndrome was incomplete in 17 cases and complete in 11 cases. Unilateral L5–S1 facet joint injury was detected in 13 cases; 14 cases had direct decompression (50 %) and 14 cases had indirect decompression (50 %). 19 patients (67.9 %) had excellent and good clinical outcome. Primary decompression had significantly increased the chances for neurological recovery ( p  = 0.024). Initial fracture kyphosis angles had a significant effect on neurological retrieval ( p  = 0.016). The mean of Gibbons score improved from 3.1 ± 0.83 preoperatively to 1.5 ± 0.84 at the end of follow-up with a highly significant impact ( p  = 0.001). Conclusions Surgical decompression and lumbopelvic segmental fixation can enhance neurological recovery and combat any structural instabilities associated with the displaced spinopelvic dissociation injuries with a hopeful clinical results.