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Spinal nerve compression after malunion of vertical sacrum fractures
Nantawit Sugandhavesa1, Noparoot Kritworakarn1, Borvornsake Rojdumrongrattana1
1Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Introduction And Importance:
Unstable pelvic ring injuries often occur in high energy traumas. Vertical sacrum fracture is an associated injury. This report describes a late spinal nerve compression that occurred following surgical reduction and fixation of pelvic ring injuries caused by traumatic L5-S1 disc herniation and malposition of the sacral fracture.
Case Presentation:
A 61-year-old female presented with radiculopathy in her right leg after surgical reduction and fixation of a sacral and pelvic fracture. Physical examination revealed numbness and weakness of the right leg. Radiographic studies showed spinal compression caused by a fracture spike from the malunion of the sacrum and protruding disc from the L5/S1 level. The fracture spikes were removed by laminectomy and discectomy after which the patient's condition had improved and she had no recurrent symptoms at the one-year follow-up.
Clinical Discussion:
Malunion of a posterior pelvic ring fracture and a herniated adjacent intervertebral disc can cause sacral nerve root compression. This complication can be managed and satisfactory results achieved by surgical intervention.
Conclusion:
Traumatic L5-S1 disc herniation and malposition following surgical reduction and fixation of a sacrum fracture can be avoided. Posterior decompression by laminectomy and discectomy is an effective alternative treatment for patients with this condition.
