Lumbopelvic Fixation for Sacral Insufficiency Fracture Presenting with Sphincter Dysfunction
Satoshi Maki1,2, Kaito Nakamura3, Tomonori Yamauchi1
1Department of Orthopaedic Surgery, Asahi General Hospital, i1326 Asahi City, Chiba 289-2511, Japan.
Case Reports in Orthopedics
|May 17, 2019
Summary
Sacral insufficiency fractures (SIFs) can cause neurological issues like bowel and bladder dysfunction. Spinopelvic fixation effectively treated a patient with SIF and neurological compromise, restoring function.
Area of Science:
- Orthopedics
- Neurology
- Radiology
Background:
- Sacral insufficiency fractures (SIFs) are prevalent in elderly individuals, often presenting with low back pain.
- Neurological deficits, such as sphincter dysfunction or leg paresthesia, are considered uncommon in SIF patients.
Observation:
- A 61-year-old woman with a history of eosinophilic granulomatosis with polyangiitis and steroid use presented with worsening low back pain.
- She developed radiating thigh pain, motor weakness in the lower extremities, and symptoms of urinary incontinence, constipation, and reduced anal sensation.
- Imaging revealed an H-shaped sacrum fracture, indicative of spinopelvic dissociation.
Findings:
- The patient's neurological symptoms were attributed to the unstable SIF.
- Lumbopelvic fixation was performed to address the spinopelvic dissociation and neurological compromise.
- Post-surgery, the patient experienced significant improvement in leg pain, urinary incontinence, and anal sensation.
Implications:
- This case highlights that even minimally displaced SIFs in osteoporotic patients can lead to significant bowel and bladder disturbances.
- Lumbopelvic fixation is presented as a viable treatment option for SIFs with spinopelvic dissociation and associated neurological deficits.
- Early diagnosis and intervention are crucial for managing SIFs and preventing long-term neurological complications.
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