[Fracture dislocation of the sacral spine with cauda equina lesion. Report of two cases (author's transl)]

Abstract

Transverse sacral fractures with cauda equina lesion appear only sporadically in the world literature. In our medical center 667 spine fractures were admitted during a twelve year period and we report only 2 cases of sacral fractures with neurological lesions (0,20%). The neurological abnormalities that occur are a perianal sensory loss with bladder and anal sphincters disturbance. Sphincters electromyographic studies and cystometric examination show a lower motor neuron lesion. In one of our cases, the nervous lesion was more spread with an unilateral sensory loss S1-S2 and a motor loss L4-L5 S1 in the same side. The high level of sacral lesion (S1-S2), the association with other pelvic fractures and fractures of the lower lumbar transverse processes, suggests the mechanism of injury (sudden flexion). Radiological studies show that sacral fractures are often difficult to detect (necessity of lateral view). Lumbar metrizamide exploration seems not very interesting. Sacral laminectomy which permits the decompression of sacral roots appears like the best treatment. The post-operative course, studied by clinical findings, electromyographic and cystometric examinations, shows the habitual resolution of neurological deficit (incomplete nevertheless in our 2 patients).