Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct 8:1:15020.
doi: 10.1038/scsandc.2015.20. eCollection 2015.

Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature

R Mahajan  1 , V Tandon  1 , K Das  1 , A Nanda  1 , R Venkatesh  1 , H S Chhabra  1
Affiliations

Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature

R Mahajan et al. Spinal Cord Ser Cases. .

Erratum in

Abstract

Study design: A retrospective study was performed.

Objectives: To analyze the outcome of two neglected sacral fractures who presented late to us after 6 weeks of injury with main complaints of incontinence and numbness in sacral region. There are no guidelines for management of complex fractures of sacrum who present late, and available literature is equally perplexing.

Methods: Patients were evaluated and radiological investigations were done. Anterior-displaced U-shaped fracture was found to be present between S2 and S3 with bony fragments encroaching the canal. Decompression with wide sacral laminectomies was done without any fixation.

Results: Case 1 showed complete recovery of bladder and perineal sensations 6 months post surgery. Second patient (case 2) had partial recovery of bladder control but numbness persisted till last follow-up at 6 months.

Conclusion: Neglected fractures of sacrum that present later than 6 weeks post injury with cauda equina syndrome could be given a chance for decompression if imaging shows canal encroachment with bony fragments. Fixation of fracture may not be required in all unstable sacral fractures after 6 weeks.

Keywords: Physiology; Surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Showing X-ray sacrum lateral view showing fracture sacrum (Case 1).
Figure 2
Figure 2
(a, b) Showing CT scan of the fracture (Case 1).
Figure 3
Figure 3
MRI showing sacral fracture (Case 1).
Figure 4
Figure 4
Intraoperative picture showing sacral nerve roots continuity after decompression (Case 1).
Figure 5
Figure 5
Showing X-ray sacrum lateral view showing fracture sacrum with spondylolisthesis (Case 2).
Figure 6
Figure 6
Showing CT scan of the fracture (Case 2).
Figure 7
Figure 7
Showing flowchart of treatment in neglected sacral fractures.
See this image and copyright information in PMC

References

    1. Routt ML Jr , Simonian PT , Swiontkowski MF . Stabilization of pelvic ring disruptions. Orthop Clin North Am 1997; 28: 369–388. - PubMed
    1. Vaccaro AR , Kim DH , Brodke DS , Harris M , Chapman JR , Schildhauer T et al. Diagnosis and management of sacral spine fractures. Instr Course Lect 2004; 53: 375–385. - PubMed
    1. Schmidek HH , Smith DA , Kristiansen TK . Sacral fractures. Neurosurgery 1984; 15: 735–746. - PubMed
    1. Sengupta DK . Neglected spinal injuries. Clin Orthop Relat Res 2005; 431: 93–103. - PubMed
    1. Rajasekaran S , Kamath V , Basu S , Gupta S . Neglected spinal trauma. In: Jain AK , Kumar S (eds). Neglected Musculoskeletal Injuries. 1st edn, Jaypee Brother Medical Publisher: Delhi, 2011, 142–159.

LinkOut - more resources