Spine trauma

As the keystone at the junction of the pelvis and the spine, the sacrum serves the vital roles of protecting lumbosacral neurologic function while maintaining pelvic and spinal column alignment. Injuries to the sacrum may result in pelvic and spinopelvic deformity, chronic pain, and loss of lower extremity, bowel, bladder, and sexual function. Treatment of sacral fractures therefore needs to optimize biomechanical and neurologic outcomes, a goal that requires a thorough understanding of spinopelvic anatomy, neurologic decompression techniques, and principles of skeletal reconstruction. The type and severity of sacral fractures varies from minimally displaced low-energy fragility fractures to widely displaced, comminuted fractures that result from high-energy injury mechanisms such as motor vehicle collisions or falls from significant heights. Sacral fractures are classified according to the AO Spine Sacral fracture classification according to the presence of posterior pelvic and spinopelvic instability, and treated accordingly. Treatment of patients with sacral fractures must take into account associated injuries in the trauma patient and the underlying medical conditions in patients with metabolic bone disease. Coordination of care between the spine surgeon, orthopedic trauma surgeon, and other surgical, medical, critical care, and rehabilitation specialists is necessary to optimize results.