J Korean Orthop Assoc.  2016 Jun;51(3):221-230. 10.4055/jkoa.2016.51.3.221.

Lumbopelvic Fixation with Iliac Screw in Spinopelvic Dissociation

• Kim WJ
• Shin HM
• Park KY
• Seong HI
• Kwon WC
• Choy WS

• KMID: 2308583
• DOI: http://doi.org/10.4055/jkoa.2016.51.3.221

Abstract

PURPOSE
Spinopelvic dissociation which occurs by high energy trauma with associated fractures is rare. Treatment is difficult and only a few studies on treatment of spinopelvic dissociation have been reported. Therefore we evaluated spinopelvic dissociation patients treated with iliac screw.
MATERIALS AND METHODS
We analyzed patients who underwent surgery using an iliac screw from 2005 to 2010. Preoperative radiologic classification was performed using the level of the transverse fracture line of the sacrum, shape of the fracture, and Roy-Camille classification. Neurologic evaluation was performed using Gibbons classification. Eleven patients underwent surgery with a pedicle screw in 1 level (L5 to S1) and bilateral iliac screws were added.
RESULTS
A total of 11 patients were included in this study. The level of the transverse fracture line of the sacrum was mainly at S2, and there were mostly type 3 or 4 in Roy-Camille classification. Bony union was checked in 11 patients without metal failure. Six of 7 patients were treated by posterior decompression. Among them, 5 patients recovered from neurological deficit and 1 patient still had a sensory disorder on both lower legs.
CONCLUSION
The more displacement of fracture, the more neurologic deficit occurred. In addition, we think that aggressive surgical treatment for spinopelvic dissociation should be considered, because a good clinical result was achieved with 1 level (L5 to S1) fixation and bilateral iliac screw fixation.

Keyword

spinopelvic dissociation; iliac screw; sacral fracture

MeSH Terms

Classification
Decompression
Humans
Hylobates
Leg
Neurologic Manifestations
Pedicle Screws
Sacrum
Sensation Disorders

Figure

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  Figure 1 A 44-year-old-female suffered spinopelvic dissociation. Preoperative computed tomography, coronal image (A), sagittal image (B), axial image (C), three-dimensional computed tomography reconstruction image (D). (E) Postoperative anteroposterior radiograph after lumbopelvic fixation with iliac screw. (F) Postoperative lateral radiograph after lumbopelvic fixation with iliac screw.

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  Figure 2 A 30-year-old-female suffered spinopelvic dissociation. (A) At 7-year postoperative, anteroposterior radiographs. (B) At 7-year postoperative, lateral radiographs.

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  Figure 3 A 66-year-old-female suffered spinopelvic dissociation and was treated 47 days after the injury. Preoperative radiograph (A), three dimensional computed tomography reconstruction image (B), coronal reconstruction image (C), sagittal reconstruction image (D), and axial reconstruction image (E). Postoperative anteroposterior radiograph (F) and lateral radiograph (G) after lumbopelvic fixation. At 1-year postoperative, anteroposterior radiograph (H), and lateral radiograph (I).

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  Figure 4 A 42-year-old-male suffered spinopelvic dissociation with pelvic ring injury and T12 bursting fracture. Preoperative computed tomography, sagittal image (A), and axial image (B). (C) Preoperative magnetic resonance imaging sagittal image. (D) External fixator application for pelvic ring fracture. (E) Postoperative anteroposterior radiograph after lumbopelvic fixation with iliac screw.

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