Outcomes of Percutaneous Versus Open Lumbopelvic Fixation of Spinopelvic Dissociation

TL;DR

This study compares percutaneous and open surgical methods for treating a severe spinal injury, finding that the less invasive approach has benefits like less blood loss and fewer infections.

Contribution

The study provides a direct comparison of outcomes between percutaneous and open lumbopelvic fixation for spinopelvic dissociation.

Findings

Percutaneous fixation resulted in significantly less blood loss and shorter operative time compared to open fixation.

The percutaneous group had fewer surgical site infections and lower operating room costs.

Percutaneous fixation was associated with a higher rate of anterior pelvic ring injuries.

Abstract

Introduction: Spinopelvic dissociation is a devastating injury that remains difficult to manage due to its complexity and low incidence. Lumbopelvic fixation is a treatment option traditionally performed with an open approach. However, open fixation is associated with substantial blood loss and infection risk in critical polytrauma patients. Technological advancements have enabled this procedure to be performed percutaneously. Thus, we evaluate outcomes between patients receiving open lumbopelvic fixation and those receiving percutaneous lumbopelvic fixation.

Methods: A retrospective review was conducted of patients undergoing either open or percutaneous lumbopelvic fixation for spinopelvic dissociation from 2012 to 2024. The AOSpine classification system was used to classify all fractures. Patient demographic, clinical, and operative outcomes were analyzed.

Results: 48 patients with spinopelvic dissociation were included in the final analysis, with 21 receiving open lumbopelvic fixation and 27 receiving percutaneous lumbopelvic fixation. Preoperative characteristics and demographics were similar between the two groups. The percutaneous group demonstrated significantly reduced blood loss (82 vs. 679 mL; p < 0.01), shorter operative time (168 vs. 284 min; p < 0.01), fewer surgical site infections (0 vs. 4; p=0.03), and reduced OR cost ($35,097 vs. $23,743; p=0.01) but had a higher rate of anterior pelvic ring injuries (63% vs. 19%; p=0.003). There was no significant difference in length of stay (p=0.63) or length of follow-up (p=0.64).

Conclusion: Our findings suggest that percutaneous lumbopelvic fixation offers an attractive less invasive and shorter procedure to treat spinopelvic dissociation without added morbidity.

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