the main aim of this study is to evaluate the results of performing minimally invasive surgical management for cases with traumatic spinopelvic instability and spinopelvic dissociation. This will include using percutaneous pedicle and S2 alar iliac screws, minimally invasive transforaminal lumbar interbody fusion and transtubular posterior decompression.
Study Procedure: 1. Patient enrollment and pre-operative evaluation: Upon Arrival, the patient will be managed in the emergency department according to the Advanced Trauma Life Support (ATLS) protocol. After achieving the haemodynamic stability, in cases of shock, X-rays (AP and lateral view of the lumbosacral region, inlet and outlet views of the pelvis) and CT scan of the pelvis will be performed. If the fracture pattern fits the inclusion criteria, the patient will be offered to enroll in the study and the patient will be prepared for surgery. 2. Surgery: The surgery will be performed under general anaesthesia and fluoroscopic guidance. The patients will be positioned prone on an open top of a radiolucent table with large bumps under the thighs to accentuate an extension force on the legs which will be the main reduction maneuver in the surgical procedure. Bilateral percutaneous L4 and L5 pedicle screws will be placed under fluoroscopic guidance with Jamshidi needles, and these were will also be used the iliac fixation via percutaneous S2 alar iliac screws. Cases presenting with significant instability, minimally invasive Transforaminal lumbar interbody fusion (MIS-TLIF) will be performed. Additionally, in cases with neurological deficit, posterior decompression will be performed. 3. Follow-up The patient will have four follow up visits (one and half month, 3month, 6month and 1 year) besides the discharge visit, during which the functional outcome scores will be filled out. AP and lateral view pelvis x-rays will be performed every visit. CT scan, AP and lateral scanograms will be only performed on the 1-year visit.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Bilateral percutaneous L4 and L5 pedicle screws will be placed under fluoroscopic guidance with Jamshidi needles, and these were will also be used the iliac fixation via percutaneous S2 alar iliac screws. Cases presenting with significant instability, minimally invasive Transforaminal lumbar interbody fusion (MIS-TLIF) will be performed. Additionally, in cases with neurological deficit, posterior decompression will be performed.
Change in the Majeed pelvic score
it is a patient reported outcome score used for functional assessment after pelvic fractures.The score ranges from 0 to 100 with 0 representing the most disability and 100 the best function.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
Short Form 12 (SF-12) score
it is a 12-item, patient-reported survey of patient health.The score ranges from 0 to 100, with higher scores indicating better physical and mental health functioning.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
Oswestry disability index (ODI):
it is a Patient-completed questionnaire which gives a subjective percentage score of level of function (disability) in activities of daily living in those rehabilitating from low back pain.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
Visual analogue scale of pain (VAS)
It is a patient reported tool for assessment of pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
AO PROST
it is a specific patient reported outcome score designed for spine trauma patients.It consists of 19 questions on a broad range of aspects of functioning on a 0-100 numeric rating scale with 0 indicating no function at all and 100 the pre-injury level of function.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
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lumbar lordosis
it will measured in degrees on plain standing lateral lumbosacral x-rays.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
Gibbons' criteria
it is a classification used to stratify patients with neurological deficit associated with pelvic injuries
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
pelvic incidence
it will be measured in degrees on plain standing lateral lumbosacral x-rays.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
AP translation
it will be measured in millimetres on inlet and outlet pelvic x-rays.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
vertical translation
it will be measured in millimetres on plain standing AP pelvic x-rays.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
sacral table angle
it will be measured in degrees on plain standing lateral lumbosacral x-rays.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery
sacral kyphosis angle
it will be measured in degrees on plain standing lateral lumbosacral x-rays.
Time frame: it will be assessed at one and half month, three month, six month and one year after the surgery