Spinopelvic dissociation in an adolescent with severe combined injury complicated by cauda equina

Introduction The clinical case demonstrated low prevalence and complexity of spinopelvic dissociation. Up‑to-date diagnostic and modern osteosynthesis techniques were used for unstable injuries of the pelvic ring and the sacrum.
The objective was to report a rare clinical case of spinopelvic dissociation in an adolescent with severe combined injury complicated by cauda equina that resulted in a positive treatment outcome.
Material and methods An adolescent patient with spinopelvic dissociation as part of a severe multi-trauma injury complicated by cauda equina was reported. Cauda equina root decompression surgery, triangular osteosynthesis and minimally invasive fixation of anterior pelvic ring fractures were performed after four days of injury because of unstable hemodynamics in the patient.
Results A positive treatment outcome was achieved in the form of life-saving, restored musculoskeletal function of the pelvis and lower limbs and complete regression of neurological dysfunction of the pelvic organs demonstrated by the Majeed pelvic score at six months and at one year of injury.
Discussion Spinopelvic dissociation as part of a severe combined injury was caused by a fall from a height in the case. A ISS score of over 25 points is classified as profound and very severe with a high risk of mortality and is often accompanied by traumatic shock. There is a high risk of neurological disorders and damage to other locations in spinopelvic dissociation. The patient suffered damage to the cauda equina roots and disturbed pelvic functions, adjacent pelvic fractures (fractures of the left acetabulum, right pubic and ischial bones), visceral injuries including contusion to the right lung and the brain. Triangular osteosynthesis is considered the method of choice for spinopelvic dissociation providing stable and biomechanically reasonable fixation system for the vertical, rotation and angulation loading on the pelvic ring. Although the risk of postoperative complications is very high and can reach 50 % with open techniques according to international literature the patient developed no postoperative complications. The treatment strategy was adequate for the teenager with spinopelvic dissociation and severe combined trauma and resulted in consolidated pelvic ring fractures and positive long-term functional outcome.
Conclusion Despite the complexity of the injury, high risk of postoperative complications and the lack of experienced specialists the teenager could survive, avoid postoperative complications and restore pelvic and lower limb function due to the coordinated work of a multidisciplinary team, timely diagnosis and modern osteosynthesis techniques used for unstable pelvic injuries.

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