Shin Caleb P, Mascarenhas Luke D, Holderread Brendan M, Awad Matthew, Botros David, Avramis Ioannis, Syed Ishaq, Rizkalla James M
Baylor University Medical Center, Department of Orthopedic Surgery, Dallas, Texas, 75246, USA.
Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, Texas, 77030, USA.
J Orthop. 2022 Aug 21;34:116-122. doi: 10.1016/j.jor.2022.08.021. eCollection 2022 Nov-Dec.
Sacral insufficiency fractures after lumbosacral fusion continue to establish themselves as a rare complication after surgery. The diagnosis can often be missed due to inconclusive imaging and non-specific symptoms. In the literature, the treatment of sacral insufficiency fractures varies from non-operative and conservative management to surgical intervention with lumbopelvic fixation.
We performed a systematic review searching the PubMed database using sacral insufficiency fracture treatment after lumbosacral fusion and sacral insufficiency fracture after posterior spinal instrumentation as keywords.
This search strategy identified 32 publications from the PubMed database for literature review. After evaluating the inclusion and exclusion criteria, a total of 17 articles were included in the review. 65% of sacral insufficiency fractures were managed surgically with 35% of patients proceeding with non-operative, conservative management only. Revision surgery always involved sacropelvic fixation which typically led to immediate resolution or reduction of symptoms, with the exception of 2 cases that did not receive adequate reduction of symptoms. Five cases reported failed non-operative management that subsequently responded to revision surgery.
Outcomes after non-operative management usually leads to symptom resolution; however has a slower symptom relief time as well as a higher chance of failed treatment. Operative outcomes, generally with a variation of sacropelvic fixation lead to immediate symptom resolution and very rarely failed treatment. Clinicians must always maintain a high index of suspicion of new onset lower back or sacral pain after lumbosacral surgery and order a CT scan to rule out a potential insufficiency fracture.
The objective of this study was to review the literature to examine treatment options for sacral insufficiency fractures after lumbosacral fusion in order to improve clinical practice and management. This systematic review of the literature regarding treatment of sacral insufficiency fractures will assist clinicians in making the accurate diagnosis and devise a strategic treatment plan for patients with sacral insufficiency fractures after spinal instrumentation.
腰骶部融合术后骶骨不全骨折仍是一种罕见的手术并发症。由于影像学检查结果不明确和症状不具特异性，诊断常常被漏诊。在文献中，骶骨不全骨折的治疗方法多种多样，从非手术保守治疗到采用腰骶骨盆固定的手术干预。
我们进行了一项系统综述，以“腰骶部融合术后骶骨不全骨折的治疗”和“后路脊柱内固定术后骶骨不全骨折”为关键词，检索了PubMed数据库。
该检索策略从PubMed数据库中识别出32篇用于文献综述的出版物。在评估纳入和排除标准后，共有17篇文章被纳入综述。65%的骶骨不全骨折采用手术治疗，35%的患者仅进行非手术保守治疗。翻修手术总是涉及骶骨盆固定，这通常能立即缓解或减轻症状，但有2例症状缓解不充分。5例报告非手术治疗失败，随后翻修手术有效。
非手术治疗的结果通常能使症状缓解；然而，症状缓解时间较慢，治疗失败的几率也较高。手术治疗的结果，一般通过不同的骶骨盆固定方式，能立即缓解症状，治疗失败的情况非常罕见。临床医生必须始终高度怀疑腰骶部手术后新发的下背部或骶骨疼痛，并安排CT扫描以排除潜在的不全骨折。
本研究的目的是回顾文献，探讨腰骶部融合术后骶骨不全骨折的治疗选择，以改善临床实践和管理。这项关于骶骨不全骨折治疗的文献系统综述将帮助临床医生做出准确诊断，并为脊柱内固定术后骶骨不全骨折的患者制定战略治疗计划。
