title: Long-term functional outcome after traumatic lumbosacral dissociation. A retrospective case series of 13 patients.
abstract: METHODS
  Retrospective case series.
  
  
  BACKGROUND
  Traumatic lumbosacral dissociation (TLSD) is a rare subgroup of sacral fractures caused by high-energy trauma in healthy adults. There are no accepted treatment algorithms for these injuries. Neurologic deficits and pain are commonly associated with these injuries, however, little is known about the long-term functional outcome in patients with TLSD. The objective of this study was to assess long-term functional outcome in patients with traumatic lumbosacral dissociation (TLSD) injuries.
  
  
  METHODS
  Thirteen patients with TLSD were retrospectively identified and followed with clinical and radiological examination mean 7.7 (3-12) years after the injury. Five were treated operatively, and eight non-operatively. Sensorimotor impairments in the lower extremities were classified according to ASIA. Urinary function was assessed with uroflowmetry, and bowel- and sexual functions were assessed using a structured interview. Pain was assessed using a visual analogue scale (VAS), and patient-reported health with SF-36. CT images were scrutinized for non-union and kyphotic angulation across the fracture.
  
  
  RESULTS
  Eleven patients had neurologic deficits corresponding to L5 and sacral roots. Urinary dysfunction was observed in nine, and bowel dysfunction in three patients. Eight patients reported problems associated with sexual activities, with pain during intercourse and erectile dysfunction being the most common problems. Twelve patients reported pain in the lumbosacral area, in combination with radiating pain in the majority. The overall patient-reported health (SF-36) was significantly lower than the normal population. All sacral fractures were united as seen on CT. Sacral kyphotic angulation was present in 11, which had increased in three patients comparing with the initial radiographs.
  
  
  CONCLUSIONS
  In this long-term follow-up, functional impairments, pain, and poor patient-reported health were common findings among patients with TLSD. High rates of neurologic, urinary and sexual dysfunctions were reported. Extended follow-up several years after the injury with a special focus on urogenital dysfunctions and pain management may be beneficial to these patients.
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway; Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Norway. Electronic address: aron.adelved@medisin.uio.no.
authors.forename: Aron
authors.initials: A
authors.lastname: Adelved
authors.affiliation: Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Tötterman
authors.affiliation: Department of Spinal Cord Injury and Multitrauma Unit, Sunnaas Hospital, Nesodden, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: Glott
authors.affiliation: Department of Radiology, Oslo University Hospital, Ullevaal, Oslo, Norway.
authors.forename: Johan C
authors.initials: JC
authors.lastname: Hellund
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Madsen
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Ullevaal, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway; Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
authors.forename: Olav
authors.initials: O
authors.lastname: Røise
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation; D009664:Norway / Q000453:epidemiology; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation*; D011183:Postoperative Complications / Q000503:physiopathology* / Q000534:rehabilitation; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation; D011859:Radiography; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000534:rehabilitation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000209:etiology / Q000534:rehabilitation; D055815:Young Adult
keywords: Long-term outcome; Lumbosacral dissociation; Neurologic deficits; Pain; Sacral kyphotic angulation; Sexual dysfunction; U-shaped sacral fractures; Urinary dysfunction