Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2017 Jan;30(1):24-28. Korean.
    Published online Jan 20, 2017.
    https://doi.org/10.12671/jkfs.2017.30.1.24
    Copyright © 2017 The Korean Fracture Society. All rights reserved.
    Case Report

    Decompressive Sacral Foraminotomy for Nerve Root Injury during Conservative Treatment of Sacral Fracture: A Case Report

    Jung-Gil Lee, M.D., Jae-Hyuk Shin, M.D., Kwon Kim, M.D., Sang-Min Choi, M.D., Moon Soo Park, M.D.,* and Ho-Guen Chang, M.D.*
      • Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
      • *Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
    • Correspondence to: Jae-Hyuk Shin, M.D. Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea. Tel: +82-2-2224-2230, Fax: +82-2-2224-2231, Email: jshin2100@gmail.com
    Received July 26, 2016; Revised September 23, 2016; Accepted October 26, 2016.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    A 35-year-old woman visited the emergency department for a pedestrian traffic accident. Severe tenderness was noted at the posterior sacrum area, without open wound or initial neurologic deficit. Fracture of the left sacral ala extended to the S1 foramen, anterior acetabulum, and pubic ramus. Two weeks after the injury, she presented aggravating radiculopathy with the weakness of the left great toe plantar flexion. The S1 nerve root was compressed by the fracture fragments in the left S1 foramen. Decompressive S1 foraminotomy was performed. The postoperative follow-up computed tomography scan showed successful decompression of the encroachment, and the patient recovered well from the radiculopathy with motor weakness. She was able to resume her daily routine activity. We suggest that early decompressive sacral foraminotomy could be a useful additional procedure in selective sacral zone II fractures that are accompanied by radiculopathy with a motor deficit.

    Keywords
    Fractures; Bone; Sacrum; Radiculopathy; Foraminotomy

    Figures

    Fig. 1
    This schematic drawing of the sacrum shows a classification of sacral fractures according to Denis et al.1) 1: Zone I-ala region; 2: Zone II-foramina region; 3: Zone III-central sacral canal region.

    Fig. 2
    A, B) Anteroposterior pelvic radiograph and 3-dimensional computed tomography (CT) shows a fracture at the left sacral ala, sacral foramina (white arrows) anterior acetabulum, and pubic ramus. Coronal (C), and axial (D) view of the CT image show S1 left foraminal encroachment by the fracture fragment (arrows).

    Fig. 3
    (A, B) T2-weighted axial images show an enlarged S1 nerve root with increased signal intensity, suggesting nerve root injury (arrow heads and arrow).

    Fig. 4
    (A-C) Decompressive S1 foraminotomy was performed. The S1 foramen was explored under an image intensifier with a penfield probe. We used a Kerrison punch (2 mm, 3 mm) in the foraminotomy, under a loupe magnification. The foraminal encroachment and nerve root release were identified with a nerve hook probe.

    Fig. 5
    (A) Postoperative computed tomography images demonstrate decompression by S1 foraminotomy (arrow head). (B) Postoperative 4 months follow-up image shows union and remodeling processes of the fracture around the S1 neural foramen.

    Notes

    Financial support:None.

    Conflict of interests:None.

    References

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    MeSH Terms
    Accidents, Traffic
    Acetabulum
    Adult
    Decompression
    Emergency Service, Hospital
    Female
    Follow-Up Studies
    Foraminotomy*
    Humans
    Neurologic Manifestations
    Radiculopathy
    Sacrum
    Toes
    Wounds and Injuries
    Metrics
    Share
    Figures
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