Reconstruction with transiliac-transsacral screws and spinopelvic fixation for combined lumbar and sacral fractures: Two case reports

We report two cases of combined lumbar vertebral and sacral fractures treated with minimally invasive reconstructive surgery comprising transiliac-transsacral (TITS) screws and spinopelvic fixation (SPF). Case 1 involved a 32-year-old Japanese male patient who fell and sustained multilevel vertebral and sacral fractures with anterior displacement and kyphosis and right pubic fracture. The patient was placed in the supine position and underwent closed reduction in the hyperextended supine position. A TITS screw was inserted at S1 and a cannulated screw was inserted in the right pubic ramus under navigation. The patient's body was then changed to the prone position. Two iliac screws were inserted on each side and percutaneous pedicle screws (PPS) were inserted from Th11 to L4 under navigation. We performed percutaneous rod placement and connected the screws. Postoperative computed tomography (CT) showed no deviation of the screws from the bone and acceptable sacral deformity reduction. Case 2 involved an 83-year-old Japanese female patient who fell and sustained L5 vertebral and fragile sacral fractures. The patient was placed in the prone position, and TITS screw insertion was performed at S1 and S2 under navigation. Iliac screws were inserted on each side and PPS were inserted at the L3 and L4 vertebrae under navigation. Postoperative CT revealed no deviation of the screws from the bone. TITS screw placement and SPF allow minimally invasive reduction and reconstruction of unstable pelvic ring injuries with lower lumbar vertebral and sacral fractures.