Spinopelvic Dissociation: A Systematic Review and Meta-analysis

Abstract

Introduction: Spinopelvic dissociation is a rare type of injury which occurs in approximately 2.9% of pelvic disruptions and correlates with high-energy trauma.The purpose of this study was to systematically evaluate the incidence, demographics, treatment, clinical outcome, and complication rate associated with these injuries.

Methods: A literature review on Medline, PubMed, and Google was performed. Overall, 216 abstracts were reviewed in English, German, and French, of which 50 articles were included.

Results: Within the 50 studies, 19 publications were case reports and 16 were case series with low-level evidence. Overall, 379 patients with spinopelvic dissociation were identified at a mean age of 31.6 ± 11.6 years and an injury severity score of 23.1 ± 3.8 between 1969 and 2018. Most cases were related to fall from heights (55.7%), followed by road accidents (28.5%). Two hundred fifty-eight patients (68.1%) showed neurologic impairment at initial presentation, which improved in 65.1% after surgery. The treatment of choice was surgery in 93.1% of cases with triangular fixation in 68.8%. Regardless of the technique, the healing/fusion rate was 100% with a complication rate of 29.9% (n = 96/321).

Conclusion: Spinopelvic dissociation is a rare type of injury with limited data in the literature. Based on our review, it is possible that a streamlined, evidence-based algorithm may improve care for these difficult patients.

Level of evidence: II.

Study design: Systematic Review.