Department of Orthopedic Surgery, National Bank Hospital for Integral Care, Cairo, Egypt.
Clin Orthop Surg. 2023 Feb;15(1):1-12. doi: 10.4055/cios21122. Epub 2023 Jan 13.
The value of direct decompression of neural structures to treat lumbosacral plexus injury associated with sacral fractures is still debatable. Direct decompression allows decompression of nerve roots by sacral laminectomy and removal of bone fragments in the spinal canal. In contrast, indirect decompression may offer similar neurological outcomes if good fracture reduction and correction of sacral kyphosis are achieved. In this comparative retrospective study, we analyzed differences between direct and indirect neurological decompression in terms of neurological recovery, complications, and functional outcome.
This study included 33 cases with spinopelvic dissociation with variable degrees of lumbosacral plexus injury. All cases were managed by spinopelvic fixation. Eighteen patients (group 1) had direct decompression of lumbosacral nerve roots while 15 patients (group 2) had indirect decompression.
Initial sacral kyphosis, quality of fracture reduction, and postoperative residual kyphosis were the main factors that significantly affected functional and neurological outcome in both groups. The final neurological improvement was similar in both groups. No significant difference was observed between both groups in the residual Gibbons' score recorded in the last visit ( = 0.206). The final Majeed score also showed no significant difference between the two groups ( = 0.869).
Indirect decompression of sacral fractures showed similar final functional outcome and neurological recovery compared to direct decompression. Restoration of lumbosacropelvic stability and anatomic reduction seem to be the cornerstone for better functional outcome and neurological recovery rather than direct decompression of neural elements.
直接减压神经结构治疗腰骶丛损伤伴骶骨骨折的价值仍存在争议。直接减压可通过骶骨椎板切除术减压神经根，并清除椎管内的骨碎片。相比之下，如果实现了良好的骨折复位和纠正骶骨后凸，间接减压也可能提供类似的神经学结果。在这项比较性回顾性研究中，我们分析了直接和间接神经减压在神经恢复、并发症和功能结果方面的差异。
本研究纳入了 33 例伴有不同程度腰骶丛损伤的骨盆脊柱分离患者。所有患者均采用骨盆脊柱固定治疗。18 例患者（组 1）行腰骶神经根直接减压，15 例患者（组 2）行间接减压。
初始骶骨后凸角、骨折复位质量和术后残余后凸角是两组患者功能和神经结局的主要影响因素。两组患者的最终神经改善情况相似。末次随访时两组的残留 Gibbons 评分差异无统计学意义（=0.206）。最终 Majeed 评分也显示两组间差异无统计学意义（=0.869）。
与直接减压相比，骶骨骨折的间接减压在最终功能结局和神经恢复方面具有相似的效果。腰骶骨盆稳定性的恢复和解剖复位似乎是改善功能结局和神经恢复的基石，而不是直接减压神经结构。
