Transverse sacral fractures

Abstract

Background context: Transverse sacral fractures (TSFs) are an uncommon type of sacral fractures. They are classified as zone III sacral fractures, but often the fracture line involves the three zones of Denis classification. A classification of TSF has been described previously but it only includes high TSF, different types of injuries as low TSF or special types of TSF are not included in this classification. Some authors advocate conservative treatment and others advocate surgical treatment for these fractures. Because TSF is an uncommon entity, spine surgeons have limited experience treating this kind of injury and consequently, a well-designed treatment protocol for these fractures does not exist.

Purpose: To review current principles in the evaluation, diagnosis, and treatment of TSFs.

Study design/setting: A literature review on TSFs.

Methods: A MEDLINE search in the English language literature was performed from 1975 to 2006. To be included in the study, it was strictly necessary for every case to provide information about the neurological status, type of treatment, and outcome. Articles in which this information was not properly mentioned were eliminated.

Results: The literature searching yielded 29 articles reporting 90 patients experiencing TSF, all of them were case reports or case series. High TSF are more frequent than low TSF and usually are caused by high-energy accidents. Ninety seven percent of patients presented some type of neurological impairment ranging from radiculopathy to bowel-bladder disturbance (BBD). Regarding the treatment, the outcome was reported using different criteria and for this reason is not possible to definitively conclude what treatment modality is the best for the treatment of TSF; however, the information obtained from every case suggest that patients treated surgically have better outcomes regarding stability and neurological status.

Conclusions: Even though both are TSF, high and low TSF have many different characteristics, the only common characteristic they share is the high incidence of cauda equina disturbance. Evidence suggests that the neurological outcome depends mainly on the anatomic characteristics of nerve roots under the fracture and severity of fracture's displacement.