Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical Center, New York, NY 10021, USA.
Spine J. 2013 Nov;13(11):1464-9. doi: 10.1016/j.spinee.2013.03.025. Epub 2013 Apr 23.
Fractures of the sacrum are a rare complication following instrumented spinal fusion, with only 34 cases previously reported in the literature. Previous series have generally been limited to less than five cases.
The purpose of this study is to determine the incidence of sacral fractures caudal to instrumented spinal fusion constructs, identify risk factors for fracture and for failure of conservative management, and describe strategies for surgical treatment of these fractures.
This is a retrospective review.
Patients undergoing instrumented posterior spinal arthrodesis between 2002 and 2011 were included in the sample.
Clinical and radiographic data from hospital and surgeon records comprise outcome measures.
Methods include a review of clinical and radiographic data from a prospectively collected patient database recording all adjacent segment fractures during the study period.
Twenty-four patients developed sacral fractures caudal to instrumented spinal fusion constructs during the study period. The overall incidence was 6.1% and was significantly greater in fusions greater than four levels (14.5%). The mean time from index surgery to fracture was 4.3 months. Only one fracture was evident on plain radiography at the onset of symptoms. Computed tomography, magnetic resonance imaging, and nuclear scintigraphy can all be used to establish the diagnosis. Eight patients were successfully treated conservatively. The mean time to fracture union was 21 weeks. Anterolisthesis of the fracture greater than 2 mm and kyphotic angulation were significantly associated with failure of conservative management. Surgical intervention included posterior extension of the fusion construct to S2 and the iliac wings with sacroiliac joint fusion. In 10 cases, a combined anterior and posterior approach was used that consisted of either revision anterior lumbar interbody fusion or transsacral posterior lumbar interbody fusion.
Sacral fractures following instrumented posterior spinal fusion are an uncommon complication; that is often unrecognized on plain radiographs. Risk factors include osteoporosis and long spinal fusions. Anterolisthesis and kyphosis of the fracture is associated with failure of conservative management.
后路脊柱融合术后发生骶骨骨折较为罕见，文献中仅有 34 例报道。既往的系列研究通常局限于不足 5 例。
本研究旨在确定后路脊柱融合术后发生于融合器下方的骶骨骨折的发生率，明确骨折和保守治疗失败的危险因素，并描述这些骨折的手术治疗策略。
这是一项回顾性研究。
纳入了 2002 年至 2011 年间接受后路脊柱关节融合术的患者。
从医院和外科医生的记录中提取临床和影像学数据作为结果测量。
该研究回顾了一个前瞻性收集的患者数据库中的临床和影像学数据，该数据库记录了研究期间所有相邻节段骨折的情况。
在研究期间，24 例患者在接受后路脊柱融合术后发生了骶骨骨折。总体发生率为 6.1%，在融合超过 4 个节段时显著增加（14.5%）。从初次手术到骨折的平均时间为 4.3 个月。只有 1 例骨折在出现症状时在普通 X 线片上可见。计算机断层扫描、磁共振成像和核闪烁成像都可用于确立诊断。8 例患者经保守治疗成功。骨折愈合的平均时间为 21 周。骨折前滑脱大于 2mm 和后凸成角与保守治疗失败显著相关。手术干预包括将融合器向后延伸至 S2 和髂骨翼，同时行骶髂关节融合。在 10 例患者中，采用了前后联合入路，包括前路腰椎椎间融合术或经骶骨后路腰椎椎间融合术的翻修。
后路脊柱融合术后发生的骶骨骨折是一种罕见的并发症，通常在普通 X 线片上无法识别。危险因素包括骨质疏松和长节段脊柱融合。骨折的前滑脱和后凸与保守治疗失败相关。
