Extended L5 pedicle subtraction osteotomy for neglected sacropelvic dissociation injury: case report

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The sacrum forms the distal end of the spine and communicates with the pelvis. Fractures involving the sacrum are complex and may disrupt this vital communication. Neglecting these fractures may result in malunion, which often causes significant alteration in the pelvic parameters and sagittal balance. Management of ensuing deformities is complex and poorly described. The authors present a case of sacral malunion with sagittal imbalance treated with a low lumbar osteotomy.

ABBREVIATIONS AP = anteroposterior; LL = lumbar lordosis; PI = pelvic incidence; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; SS = sacral slope; SVA = sagittal vertical axis.

Article Information

Correspondence Tarush Rustagi: Swedish Neurosciences Institute, Seattle, WA. tarush.rustagi@gmail.com.

INCLUDE WHEN CITING Published online March 29, 2019; DOI: 10.3171/2019.1.SPINE181271.

V.S. and T.R. contributed equally to this work.

Disclosures Dr. Hart has the following disclosures. Honoraria, consultation, and royalties: Globus, Seaspine, DePuy Synthes, Medtronic, Orthofix. The International Spine Study Group Foundation (ISSGF) provides study funding for other projects.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative standing anteroposterior (AP) and lateral radiographs. Thoracic (43°) and lumbar (46°) curves can be seen on AP radiographs. Sacral malunion with acute angulation (77°). The SVA is measured at +7.8 cm. Figure is available in color online only.

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    A: CT scans showing inadequate fusion at the L4–5 intervertebral level. B: CT myelograms showing no stenosis.

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    Illustrations of surgical steps. A: Showing normal alignment, with PI (green lines) and LL (blue lines) relationship. B: Following sacral malunion, with exaggeration of PI. The planned area of L5 osteotomy is marked out (pink area). C: Following surgical correction with PSO and anterior support using structural graft (red grafts). Figure is available in color online only.

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    A: Final follow-up standing AP and lateral radiographs. SVA has been realigned to +1.2 cm. B: Sagittal CT image showing L5 osteotomy. Figure is available in color online only.

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