Isolated Decompression for Transverse Sacral Fractures with Cauda Equina Syndrome

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Trauma Surgery

Background:

• Transverse sacral fractures with cauda equina syndrome are rare injuries.
• Clinical outcomes of isolated decompression for these fractures are not well-documented.

Purpose of the Study:

• To evaluate the clinical outcomes of isolated decompression in patients with transverse sacral fractures and cauda equina syndrome.
• To assess the efficacy of isolated decompression in achieving bony union, pelvic outcome, and neurological recovery.

Main Methods:

• Retrospective evaluation of 12 neurologically impaired patients with transverse sacral fractures treated with isolated decompression.
• Follow-up for a minimum of 12 months, assessing fracture causes, classifications, associated injuries, radiologic results, Majeed index, and Gibbons criteria.
• Surgical procedures included laminectomy (up to 3 segments or S1-S4 excision) and L5 laminectomy for lumbopelvic joint involvement.

Main Results:

• Major causes of trauma were motor vehicle accidents and falls; average time to surgery was 89.8 days.
• All patients achieved bony union, with 63.6% showing satisfactory pelvic outcomes.
• Average Gibbons scores improved from 2.8 to 1.9 at 18-month follow-up, though most patients reported residual pain. No surgical complications occurred.

Conclusions:

• Isolated decompression is a suitable option for stable, non-displaced transverse sacral fractures or old, healed fractures.
• The procedure can yield favorable pelvic outcomes and neurological recovery.
• Acceptable spinal stability can be achieved with isolated decompression in select patients.