Isolated u-shaped sacral fracture with cauda equina injury
Hong-Wei Chen1, Guo-Dong Liu, Gang-Sheng Zhao
1Department of Orthopedics, Central Hospital of Yiwu City, Yiwu, China. chw6988@yahoo.com.cn
Orthopedics
|April 8, 2011
Summary
Isolated U-shaped sacral fractures with cauda equina injury are rare but treatable. Posterior vertebral plate decompression and fixation offer a safe and effective treatment option with good outcomes.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Trauma Surgery
Background:
- U-shaped sacral fractures combined with cauda equina injury are rare and present diagnostic and therapeutic challenges.
- The typical mechanism involves falls from height, leading to direct sacral impact and vertical spinal column energy extrusion.
Observation:
- Diagnosis is often delayed due to the fracture's subtle appearance on standard pelvic radiographs.
- Computed tomography (CT) scans with coronal and sagittal reconstruction are crucial for accurate diagnosis.
Findings:
- Two patients with U-shaped sacral fractures and cauda equina injury were successfully treated with posterior sacral laminectomy and internal fixation within one week.
- Postoperative recovery was satisfactory, with bony union achieved and no hardware complications or wound issues noted during follow-up.
Implications:
- Posterior vertebral plate decompression and internal fixation represent a viable surgical approach for this rare injury pattern.
- This technique offers a satisfactory outcome with minimal operative trauma and a low complication rate.
Related Concept Videos
01:29Herniated Intervertebral Disc l: Introduction
Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
01:14Spinal Cord Injury ll: Pathophysiology
Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...
01:25Secondary Spinal Cord Injury llI: Pathophysiology
Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...