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