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Lumbopelvic fixation in the treatment of spinopelvic dissociation: union, complications, and neurologic outcomes of a multicenter case series

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To review outcomes of spinopelvic dissociation treated with open lumbopelvic fixation.

Methods

We reviewed all cases of spinopelvic dissociation treated at three Level-I trauma centers with open lumbopelvic fixation, including those with adjunctive percutaneous fixation. We collected demographic data, associated injuries, pre- and postoperative neurologic status, pre- and postoperative kyphosis, and Roy-Camille classification. Outcomes included presence of union, reoperation rates, and complications involving hardware or wound.

Results

From an initial cohort of 260 patients with spinopelvic dissociation, forty patients fulfilled inclusion criteria with a median follow-up of 351 days. Ten patients (25%) had a combination of percutaneous iliosacral and open lumbopelvic repair. Average pre- and postoperative kyphosis was 30 degrees and 26 degrees, respectively. Twenty patients (50%) had neurologic deficit preoperatively, and eight (20%) were unknown or unable to be assessed. All patients presenting with bowel or bladder dysfunction (n = 12) underwent laminectomy at time of surgery, with 3 patients (25%) having continued dysfunction at final follow-up. Surgical site infection occurred in four cases (10%) and wound complications in two (5%). All cases (100%) went on to union and five patients (13%) required hardware removal.

Conclusion

Open lumbopelvic fixation resulted in a high union rate in the treatment of spinopelvic dissociation. Approximately 1 in 6 patients had a wound complication, the majority of which were surgical site infections. Bowel and bladder dysfunction at presentation were common with the majority of cases resolving by final follow-up when spinopelvic dissociation had been treated with decompression and stable fixation.

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Funding

No outside funding was received in support of this research or in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN, 37232, USA

    Justin P. Moo Young, Jonathan C. Savakus, Cade A. Morris, Jeffrey M. Hills, Phillip M. Mitchell & Byron F. Stephens

  2. Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA

    Mitchel R. Obey, Daniel E. Pereira & Anna N. Miller

  3. Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Ava McKane & Sharon N. Babcock

Authors
  1. Justin P. Moo Young
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  2. Jonathan C. Savakus
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  3. Mitchel R. Obey
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  4. Cade A. Morris
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  6. Jeffrey M. Hills
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  9. Anna N. Miller
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  10. Phillip M. Mitchell
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Corresponding author

Correspondence to Phillip M. Mitchell.

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Conflict of interest

Dr. Moo Young declares that he has no conflicts of interest. Dr. Savakus declares that he has no conflicts of interest. Dr. Obey declares that he has no conflicts of interest. Dr. Morris declares that he has no conflicts of interest. Dr. Pereira declares that he has no conflicts of interest. Dr. Hills declares he has no conflicts of interest. Ms. Mckane declares she has no conflicts of interest. Dr. Babcock declares she has no conflicts of interest. Dr. Miller has held leadership/fiduciary roles for Orthopaedic Trauma Association, American College of Surgeons, American Orthopaedic Association, and American Academy of Orthopaedic Surgeons. Dr. Mitchell has received a research grant from J&J. Dr. Stephens has received research grants from Nuvasive spine and Stryker spine.

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Moo Young, J.P., Savakus, J.C., Obey, M.R. et al. Lumbopelvic fixation in the treatment of spinopelvic dissociation: union, complications, and neurologic outcomes of a multicenter case series. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03928-4

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