Background

Spinopelvic dissociation is an injury to the posterior pelvic ring in which the upper part of the sacrum remains connected to the lumbar spine and the lower part of the sacrum remains attached to the pelvis. Multiplanar sacral fractures with concomitant spinopelvic dissociation frequently result from high-energy trauma, are associated with neurologic injury, and are a challenge to manage. As surgical techniques have evolved, management has become predominantly surgical, which enables earlier mobilization and results in improved long-term outcomes. Fixation at the lumbosacral junction is a challenge. Although many spinopelvic fixation techniques have been described, lumbar fusion to the sacrum via iliosacral screw fixation is frequently performed.

Purpose

This video demonstrates lumbopelvic fixation and iliosacral fixation for the management of sacral fractures in patients with spinopelvic dissociation.

Methods

The anatomy, classification, diagnosis, and management of spinopelvic dissociation is reviewed. Surgical indications and considerations, including approach and fixation, are discussed. The case presentation of a 55-year-old man with spinopelvic dissociation and sacral fractures after jumping from a building during a suicide attempt is reviewed. Iliosacral screw fixation followed by spinopelvic screw fixation and instrumentation were performed. Results Anatomic reduction and stable fixation was achieved intraoperatively. Radiographic reduction was maintained without complications.

Conclusion

Spinopelvic dissociation is a challenging injury that often results in serious sequelae. Spinopelvic dissociation may be missed initially because of unfamiliarity with the discerning radiographic findings and the presence of distracting injuries. Iliosacral screw fixation and lumbopelvic fixation frequently are performed in patients with sacral fractures and spinopelvic dissociation. This technique successfully stabilizes lumbopelvic injuries.