Spinopelvic Dissociation - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The sacrum is a large shield-shaped bone located at the spine's base. The sacral vertebrae fuse to form the sacral bone. The sacrum is connected to the pelvis and forms the posterior wall of the pelvis. Transverse fracture in the sacrum causes the pelvis to dissociate from the sacrum, resulting in spinopelvic dissociation.

What Is Spinopelvic Dissociation?

Spinopelvic dissociation is a transverse fracture of the sacrum along with a verticle fracture of the sacrum on both sides, which results in the separation of the upper part of the sacrum and spine from the pelvis. In this condition, there is a complete disruption of the bony and ligamentous connections between the spine and the pelvis. Spiniopelvic dissociation is a very rare condition that is mainly caused by high-energy injuries and often occurs in association with other severe injuries.

What Are the Causes of Spinopelvic Dissociation?

Spinopelvic dissociation mainly occurs as a result of high-energy trauma. Some causes of spinopelvic dissociation include

• In motor vehicle accidents, the patient suffers severe impact on the lower back.

• Sports injuries - Contact sports and sports involving high-impact movements, like football, gymnastics, etc., may cause spinopelvic dissociation.

• Falls from a significant height result in damage to the pelvis and spine.

• Severe acts of violence may also cause spinopelvic dissociation.

• In rare cases, certain conditions that cause the bones to weaken may increase the risk of spinopelvic dissociation, for example., osteoporosis or cancer.

What Are the Symptoms of Spinopelvic Dissociation?

Spinopelvic dissociation is a severe condition often associated with multiple traumas. The patient is unconscious and intubated in most cases.

The symptoms of spinopelvic dissociation include the following.

• Severe pain in the lower back, hips, and pelvis.

• Visible deformities in the lower back or pelvis include spine misalignment, etc.

• Difficulty standing and walking due to instability in the pelvis and spine.

• Numbness or tingling in the lower limbs due to nerve damage.

• Shock that results in rapid heartbeat, difficulty breathing, and low blood pressure.

• Bowel and bladder dysfunction occur in severe cases.

How Is Spinopelvic Dissociation Diagnosed?

Early diagnosis and treatment are mandatory for a better functional prognosis of the affected individual. Diagnosis involves a combination of clinical assessment, imaging tests, and neurological tests of the patient. A thorough medical history of the patient and the circumstances surrounding the injury are also recorded to help with the diagnosis.

• Clinical Examination: A thorough clinical examination is done to locate the pain and fractures. Pelvic ring stability is assessed by using slight rotational movements. A rectal exam and a vaginal exam in women are performed. This is done to check for any open fractures and perforations of the vagina and rectum.

• Neurological Assessment: A complete neurological examination is done to check for nerve damage at the lumbar and sacral levels. Testing reflexes and sensations in the legs is done. Multiple nerve damage in the lumbar and sacral nerve roots may result in cauda equina syndrome, characterized by bladder incontinence, decreased tone of the anal sphincter, and numbness of the legs.

• Imaging Tests: X-ray views, which include posteroanterior, lateral, and inlet or outlet views, are taken to help with the diagnosis. A step ladder sign in the X-ray suggests spinopelvic dissociation. CT scans of the spine and pelvis are taken to diagnose the fracture pattern. CT scans also help in decision-making regarding treatment procedures. Sagittal and coronal plane sections of CT scans are more useful in diagnosis. MRI can provide information on the nerve compression areas and the displacement of the bone fragments.

How Is Spinopelvic Dissociation Treated?

The treatment involves a combination of surgical intervention and rehabilitation to stabilize the spine and pelvis, restore alignment, and promote healing. The treatment of spinopelvic dissociation is complex and requires a multidisciplinary approach involving a team of medical professionals, including orthopedic surgeons, neurosurgeons, physical therapists, and occupational therapists. The treatment aims to restore stability and function in the spine and pelvis, minimize pain and disability, and help patients regain independence and quality of life.

Initial Treatment

Initially, after the trauma, the patient is fully assessed, diagnosed, and treated using the advanced trauma life support protocol (ATLS). The objective of the ATLS protocol is to treat the greatest threat to life first. Stabilization of the pelvis and spine.

Definitive Treatment

• Previously, nonsurgical treatment was the option used for spinopelvic dissociation. But in recent days, surgical intervention has been the treatment procedure.

• Neurological decompression - A laminectomy is done in the sacral area to remove bone fragments directly, which facilitates the decompression of the nerves.

• Direct and indirect maneuvers reduce fractures. The reduction should be aimed at restoring the normal spinopelvic alignment.

• Surgical options include iliosacral screws and plating.

• Triangular osteosynthesis is a recent and more appropriate approach to treating displaced sacral fractures.

Rehabilitation and Physiotherapy

Rehabilitation and physiotherapy are also critical components of the treatment plan for spinopelvic dissociation. Physiotherapy helps patients by restoring strength and mobility in the affected area to manage pain and prevent further complications. Occupational therapy helps patients perform daily activities safely and effectively while recovering.

What Are the Complications Due to Spinopelvic Dissociation?

Spino-pelvic dissociation is a serious and potentially life-threatening injury that can cause a range of complications, depending on the severity and extent of the injury.

• Neurological complications due to nerve damage or dysfunction may include numbness, tingling, weakness, or loss of function in the lower limbs or other body parts.

• Infection in the affected area.

• Chronic pain in the lower back, hips, and pelvis.

• If the injury damages the blood vessels or other organs, blood loss is present.

• Long-term or permanent disability in more severe cases.

• Organ damage, particularly bowel or bladder damage, may be present.

• Psychological trauma due to the impact of the injury on the quality of the affected individual’s life.

Conclusion

Spinopelvic dissociation can cause complications that may be severe and require ongoing treatment and management. However, with prompt and effective treatment, many patients with spinopelvic dissociation can regain some or all of their mobility and function and can go on to lead fulfilling lives. The key to achieving the best possible outcome is early diagnosis and treatment, as well as ongoing care and support to manage any ongoing symptoms or complications.