Percutaneous Posterior Pelvic Fixation of Spinopelvic Dissociation: A Multicenter Series of Displaced Patterns

Justin P. Moo Young, Jonathan C. Savakus, Mitchel R. Obey, Daniel E. Pereira, Jeffrey M. Hills, Ava McKane, Sharon N. Babcock, Anna N. Miller, Byron F. Stephens, Phillip M. Mitchell

Research output: Contribution to journalArticlepeer-review

Abstract

Objective:To characterize the success and complications of percutaneous posterior pelvic fixation in the treatment of displaced spinopelvic dissociation patterns.Design:Retrospective cohort study.Setting:Three Level I trauma centers.Patients:53 patients with displaced spinopelvic patterns were enrolled.Intervention:Percutaneous iliosacral screw fixation was used.Main outcome measures:Main outcome measures include incidence of union, fixation failure, and soft tissue complications.Results:All patients had displaced, unstable patterns with a mean preoperative kyphosis of 29.7 ± 15.4 degrees (range, 0-70). Most of the patients treated were neurologically intact (72%) or had an unknown examination at the time of fixation (15%). The median follow-up was 254 days (interquartile range, 141-531). The union rate was 98%. Radiographic and clinical follow-up demonstrated 1 case (2%) of nonunion. Two patients (4%) had radiographic evidence of screw loosening at the final follow-up, both of whom had fixation with a single sacroiliac-style screw placed bilaterally and went on to uneventful union. Neurologic recovery occurred at an average of 195 ± 114 days (range, 82-363 days). When present, long-term neurologic sequelae most commonly consisted of radicular pain and paresthesias at the final follow-up (n = 3, 6%).Conclusions:Percutaneous posterior pelvic fixation of select displaced spinopelvic dissociation seems to be safe with a low complication rate and reliable union. In a cohort of displaced fractures that were fixed in situ, we found a 2% rate of fixation failure/nonunion. Although rare, radicular pain and paresthesias were the most common long-term neurologic sequela.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)371-376
Number of pages6
JournalJournal of orthopaedic trauma
Volume37
Issue number8
DOIs
StatePublished - Aug 1 2023

Keywords

  • spinopelvic dissociation
  • u-shaped sacral fracture
  • u-type sacral fracture

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