Citation

Helgeson MD, Lehman RA, Cooper P, Frisch M, Andersen RC, Bellabarba C. Spine 2011; 36(7): E469-75.

Affiliation

1 Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Washington, DC 20307 2 Associate Professor, Uniformed Services University of the Healthy Sciences, Bethesda, MD 3 Neurosurgery Service, Walter Reed Army Medical Center, Washington, DC 20307 4 Department of Orthopaedics, Mission Medical Associates Asheville, NC 28806 5 Spine Surgery Service, University of Washington, Seattle, WA.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e3182077fd7

PMID

21358474

Abstract

STRUCTURED ABSTRACT: Study Design: Retrospective review of medical records and radiographs.Objective: We assessed the clinical outcomes of lumbosacral dissociation (LSD) following traumatic, combat-related injuries, and to review our management of these distinct injuries and report our preliminary follow-up.Summary of Background Data: LSD injuries are an anatomic separation of the pelvis from the spinal column, and are the result of high-energy trauma. A relative increase in these injuries has been seen in young healthy combat casualties subjected to high-energy blast trauma.Methods: We performed a retrospective review of inpatient/outpatient medical records and radiographs for all patients treated at our institution with combat-related lumbosacral dissociations. 23 patients met inclusion criteria of combat-related lumbosacral dissociations with one-year follow-up. Patients were treated as follows: no fixation (9), sacroiliac screw fixation (8), posterior spinal fusion (5) and sacral plate (1). All patients with radiographic evidence of a zone III sacral fracture, in addition to associated lumbar fractures indicating loss of the iliolumbar ligamentous complex integrity were included.Results: In 15 patients, the sacral fracture were an H or U type zone III fracture, while in the remaining 9, the sacral fracture was severely comminuted and unable to classify (6 open fractures). There was no difference in visual analog scale (VAS) between treatment modalities. Two open injuries had residual infections. One patient treated with an L4-ilium posterior spinal fusion with instrumentation required instrumentation removal for infection. At a mean follow-up of 1.71 years (range, 1-4.5), 11 patients (48%) still reported residual pain and the mean VAS at latest follow-up was 1.7 (range, 0-7).Conclusion: Operative stabilization promoted healing and earlier mobilization, but carries a high postoperative risk of infection. Nonoperative management should be considered in patients whose comorbidities prevent safe stabilization.

Language: en