CONCOMITANT NONCONTIGUOUS THORACOLUMBAR AND SACRAL FRACTURES

Seventeen patients were identified with concomitant thoracolumbar and sacral fractures representing 26% of sacral fractures and 7.7% of pelv ic fractures. The thirteen men and four women exhibited a bimodal age distribution. There were thirteen vertical compression thoracolumbar f ractures, three transverse process fractures, and one traumatic hernia ted nucleus pulposus. There were seven Zone I, seven Zone II, and thre e Zone III sacral fractures using the Denis classification. Five of th e sacral fractures were missed on initial presentation. Four of the pa tients had neurogenic bowel or bladder symptoms. Seven of the thoracol umbar fractures and three of the sacral fractures were treated operati vely. Results were generally good or excellent unless significant neur ologic injury was present at initial presentation. The authors recomme nd agressive computed tomographic evaluation of the sacrum in any susp icious pelvic trauma or when the neurologic lesion does not match the more proximal bony lesion. They hypothesize that decompression of both sacral and thoracolumbar lesions may be necessary if either lesion co uld be responsible for neurogenic bowel or bladder symptoms.