Traumatic spondylopelvic dissociation. A case report and literature review.

Abstract

A case of traumatic spondylopelvic dissociation and a method of fixation are described. The treatment of this rare injury pattern required differentiation from less severe lumbosacral fracture-dislocations or bilateral sacroiliac joint dislocations. Several case reports have described less severe fracture patterns, but only a handful have illustrated true spondylopelvic dissociation in which there is complete displacement of the lumbar spine into the pelvis. After initial stabilization at an outside hospital, the patient was transferred to the authors' institution for definitive care. After computed tomography imaging with three-dimensional multiplanar reconstruction, the fracture was stabilized with a pedicle screw construct attached to the pelvis by means of the Galveston technique. Bilateral iliosacral screws were used to increase stability. At a 2-year follow-up, the patient was pain-free and ambulating in an ankle-foot orthosis. He had a persistent deficit involving the right L5 and S1 nerve roots but was continent of stool. The unique fracture pattern described in this patient is presented to offer better insight into management of this complex injury and to delineate it from simpler patterns of injury to the lumbosacral junction.