Radiological findings correlate with neurological deficits but not with pain after operatively treated sacral fractures.
OBJECTIVE
Neurological deficits and pain are common after displaced sacral fractures. However, little is known about the association between the long-term clinical outcomes and radiological findings. We examined the long-term radiological findings and their correlations with lumbosacral pain and neurological deficits in the lower extremities after surgery for sacral fractures.


METHODS
28 consecutive patients with operatively treated displaced sacral fractures were followed for mean 11 (8-13) years. Sensorimotor impairments of the lower extremities were classified according to the American Spinal Injury Association (ASIA). Pain was assessed using a visual analog scale (VAS). All patients underwent conventional radiographic examination and CT, and the images were scrutinized for nonunion, residual displacement, narrowing of the sacral foramina, and post-foraminal encroachment of the L5 and S1 nerves.


RESULTS
There was residual displacement of ≥ 10 mm in 16 of the 28 patients. 26 patients had narrowing of 1 or more neural root foramina in L5-S4. 8 patients reported having no pain, 11 had pain only in the lumbosacral area, and 9 had pain in combination with radiating leg pain. Statistically significant correlations were found between narrowing of the sacral foramina and neurological deficits in the corresponding dermatomes. Significant correlations were also found between post-foraminal encroachment of L5 nerves and both sensory and motor deficits. No correlations were found between pain and radiological findings.


CONCLUSIONS
Pathological radiological findings are common 11 years after operatively treated displaced sacral fractures. Sacral foraminal and L5 post-foraminal bony encroachments were common findings and correlated with neurological deficits. However, lumbosacral pain did not correlate with radiological sequelae after fracture healing.
Department of Orthopaedics , Division of Surgery and Clinical Neuroscience, Oslo University Hospital , Ullevaal.
Aron
A
Adelved
Anna
A
Tötterman
Johan C
JC
Hellund
Thomas
T
Glott
Jan Erik
JE
Madsen
Olav
O
Røise
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators; D017116:Low Back Pain / Q000000981:diagnostic imaging*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000601:surgery; D010149:Postoperative Pain / Q000000981:diagnostic imaging*; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000601:surgery; D012042:Registries; D012447:Sacrum / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed