Elsevier

Injury

Volume 47, Issue 7, July 2016, Pages 1562-1568
Injury

Long-term functional outcome after traumatic lumbosacral dissociation. A retrospective case series of 13 patients

https://doi.org/10.1016/j.injury.2016.04.006Get rights and content

Absract

Study design

Retrospective case series.

Introduction

Traumatic lumbosacral dissociation (TLSD) is a rare subgroup of sacral fractures caused by high-energy trauma in healthy adults. There are no accepted treatment algorithms for these injuries. Neurologic deficits and pain are commonly associated with these injuries, however, little is known about the long-term functional outcome in patients with TLSD. The objective of this study was to assess long-term functional outcome in patients with traumatic lumbosacral dissociation (TLSD) injuries.

Materials and methods

Thirteen patients with TLSD were retrospectively identified and followed with clinical and radiological examination mean 7.7 (3−12) years after the injury. Five were treated operatively, and eight non-operatively. Sensorimotor impairments in the lower extremities were classified according to ASIA. Urinary function was assessed with uroflowmetry, and bowel- and sexual functions were assessed using a structured interview. Pain was assessed using a visual analogue scale (VAS), and patient-reported health with SF-36. CT images were scrutinized for non-union and kyphotic angulation across the fracture.

Results

Eleven patients had neurologic deficits corresponding to L5 and sacral roots. Urinary dysfunction was observed in nine, and bowel dysfunction in three patients. Eight patients reported problems associated with sexual activities, with pain during intercourse and erectile dysfunction being the most common problems. Twelve patients reported pain in the lumbosacral area, in combination with radiating pain in the majority. The overall patient-reported health (SF-36) was significantly lower than the normal population. All sacral fractures were united as seen on CT. Sacral kyphotic angulation was present in 11, which had increased in three patients comparing with the initial radiographs.

Conclusion

In this long-term follow-up, functional impairments, pain, and poor patient-reported health were common findings among patients with TLSD. High rates of neurologic, urinary and sexual dysfunctions were reported. Extended follow-up several years after the injury with a special focus on urogenital dysfunctions and pain management may be beneficial to these patients.

Introduction

Traumatic lumbosacral dissociation (TLSD) is a rare subgroup of sacral fractures mostly reported as single cases or small case series [1], [2], [3], [4], [5]. It is also commonly denoted as a U or H-shaped sacral fracture, and mainly results from high energy trauma, such as fall from height or motor vehicle accidents [6]. Combat-related blast injuries have also been reported recently [7]. Neurologic deficits in the lower extremities and pain are common findings in patients after TLSD [8], [9], [10]. There is a lack of good quality reports documenting which fractures need to be treated operatively and which can be treated non-operatively. Furthermore, little information is available on functional outcome of these injuries, regarding neurologic and urogenital functions, residual pain, as well as patient-reported health in a long-term perspective.

The aim of this study was to assess long-term functional outcome, patient-reported health and radiological outcome in patients with TLSD.

Section snippets

Materials and methods

In this retrospective study, all patients with traumatic lumbosacral dissociation (TLSD) were identified from the Pelvic Fracture Registry at Oslo University Hospital, Ullevaal during the period of March 1997 to September 2006. Low energy, osteoporotic fractures or sacral insufficiency fractures, as well as sacral fractures as part of pelvic ring disruptions were excluded. Nineteen patients met the inclusion criteria, of which three were foreign residents and two were deceased. Of the remaining

Results

The mean follow-up time was 7.7 years (range 3−12) post-injury, with a female: male ratio of 5:8, and mean age of 42 years (range 21−64). Mean injury severity score (ISS) was 23 (range 9−50). In five cases, the mechanism of injury was fall from height, including three suicidal jumps, and in the remaining eight cases, motor vehicle accidents (MVA). Patient characteristics, including fracture types and treatments are shown in Table 1.

Only two patients had normal neurologic function at follow-up,

Discussion

In the current study, we evaluated the long-term functional outcome in 13 patients after traumatic lumbosacral dissociation (TLSD) injuries with a follow-up time of seven (3−12) years. We found considerable morbidity in the majority of our patients, including neurologic sequelae in the lower extremities, bladder dysfunction and chronic pain. The patient-reported health scores, measured by the SF-36 were significantly lower than the normal population, and limitations in sexual activities were

Conclusion

In this long-term follow-up of patients after traumatic lumbosacral dissociation injuries, all the sacral fractures united and the majority of patients were independent in ambulation and ADL. However, functional impairments and pain were common findings. High rates of neurologic deficits, urinary bladder dysfunction and limitations in sexual activities were found, and patient-reported health was significantly lower than the normal population. The correlation between these impairments and the

Conflicts of interest

None declared.

Acknowledgments

This work was partly supported by research funds from Sophies Minde Foundation, Oslo, Norway. The funds were merely used to cover the operational costs of the study. The sponsor had no involvement in the study design; collection, analysis and interpretation of data; the writing of the manuscript; the decision to submit the manuscript for publication.

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