1310. Instrumented Lumbosacral Fusion In Sacral Type III Fractures With Kyphotic Deformity In Children

Authors: Muhammad Burhan Ud Din Janjua, MD; Dale Swift, MD; Bruno Braga, MD (Dallas, TX)

Introduction: Sacral fractures result from axial loading or shear forces and are relatively uncommon in pediatrics. Neurological deficits occur in 22-60% of cases. Surgery has a special role in neurological injuries, helps in pain control, and early ambulation. Authors describe surgical management in pediatrics with the help of their own case example. Methods: 12-year-old girl who sustained sacral fracture in a motor vehicle accident as a back-seat passenger. Her symptoms back pain, and in ability to stand and walk worsened over the course of 24hrs with new onset of left lower extremity radicular symptoms. Clinical presentation, radiographic details, and surgical technique have been discussed. PUBMED Medline literature search was also performed to high light the management of sacral fractures in pediatrics. Results: The patient had a rapid progression of severe back pain, lack of ambulation, and radicular symptoms. Her radiological imaging was reminiscent of type III sacral fracture with marked regional kyphotic deformity and retropulsed bony fragments into the sacral spinal canal, and left L5/S1 neural foramen. Authors treated the deformity with an instrumented fusion. The patient’s symptoms completely resolved with an excellent radiographic outcome. On a last 4 years follow-up visit patient was observed to be completely healthy without any limitations from surgery. Conclusion: Detail imaging with CT and MR scan of lumbosacral spine is strongly recommended in sacral fractures with symptoms of severe back and/or neurological deficit. Open reduction and an instrumented lumbosacral fusion is well tolerated in children with type III sacral fractures associated with the regional kyphotic deformity.