LAUSR

OBJECTIVE To characterize the success and complications of percutaneous posterior pelvic fixation in the treatment of displaced spinopelvic dissociation patterns.Design: Retrospective cohort study.Setting: Three Level I trauma centers.Patients: Fifty-three patients with displaced spinopelvic patterns.Intervention: Percutaneous iliosacral screw fixation.Main outcome measures: Incidence of union, fixation failure and soft tissue complications. RESULTS All patients had displaced, unstable patterns with a mean pre-operative kyphosis of 29.7 ± 15.4 degrees (range, 0-70). The majority of patients treated were neurologically intact (72%) or had an unknown exam at the time of fixation (15%). The median follow-up was 254 days (Interquartile range, 141-531).The union rate was 98%. Radiographic and clinical follow-up demonstrated one case (2%) of nonunion. Two patients (4%) had radiographic evidence of screw loosening at final follow-up, both of whom had fixation with a single sacroiliac style screw placed bilaterally and went on to uneventful union. Neurologic recovery occurred at an average of 195 ± 114 days (range, 82-363 days). When present, long-term neurologic sequelae most commonly consisted of radicular pain and paresthesias at final follow-up (n=3, 6%). CONCLUSIONS Percutaneous posterior pelvic fixation of select displaced spinopelvic dissociation appears to be safe with a low complication rate and reliable union. In a cohort of displaced fractures that were fixed in situ, we found a 2% rate of fixation failure/nonunion. While rare, radicular pain and paresthesias were the most common long-term neurologic sequela.