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

Justin P Moo Young; Jonathan C Savakus; Mitchel R Obey; Cade A Morris; Daniel E Pereira; Jeffrey M Hills; Ava McKane; Sharon N Babcock; Anna N Miller; Phillip M Mitchell; Byron F Stephens

doi:10.1007/s00590-024-03928-4

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

Eur J Orthop Surg Traumatol. 2024 Apr 11. doi: 10.1007/s00590-024-03928-4. Online ahead of print.

Affiliations

¹ Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN, 37232, USA.
² Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.
³ Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁴ Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, #4200, Nashville, TN, 37232, USA. p.mitchell91@gmail.com.

PMID: 38605242
DOI: 10.1007/s00590-024-03928-4

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.

Keywords: Lumbopelvic fixation; Roy-Camille; SPD; Spinopelvic dissociation.