Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability

Sacral fractures with both transverse and bilateral vertical fracture components are by definition multiplanar fractures, and often present with spinopelvic instability and cauda equina deficits. The treatment is challenging. Between 2006 and 2009, we treated nine such patients at our trauma centre. There were six men and three women, with a mean age of 32.2 years. Preoperative neurologic deficits were noted in seven patients; four patients had complete cauda equina paralysis, and three patients had incomplete cauda equina syndrome. All patients were treated using lumbopelvic instrumented fixation without other devices for their multiplanar sacral fractures. Six patients who had neurological deficits and sacral canal compression underwent decompression laminectomy. The mean postoperative follow-up time was 21.7 months (range, 14-32 months). All fractures went on to union without loss of reduction or hardware failure. The mean Gibbons score improved from 3.5 preoperatively to 2.3 postoperatively among the patients who underwent decompression laminectomy. Eight out of nine patients had fair or better results based on radiographic criteria and the Majeed pelvic fracture outcome score. Our experience suggests lumbopelvic fixation can be used for the treatment of multiplanar sacral fractures with spinopelvic instability with a low rate of complications. Neurologic improvement can be expected, but whether surgical decompression results in substantially better neurologic recovery than conservative treatment remains uncertain.