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OBJECTIVES: Historically, fractures causing lumbopelvic dissociation have been managed with open lumbosacral fusion and instrumentation. Our aim was to evaluate outcomes and complications following surgical management of unstable transverse sacral fractures with percutaneous lumbopelvic fixation. METHODS: Design: Retrospective case series. SETTING: Academic Single Center, Level I Trauma Center. Patient Selection Criteria: Patients with lumbopelvic dissociation undergoing surgery. Outcome Measures and Comparisons: Patient demographics, mechanism of injury, ISS, associated injuries, radiographic classification (Roy-Camille), patient-reported outcomes (PROMIS PI, PF, D, and ODI), and complications were collected. RESULTS: 27 patients were enrolled with an average follow-up of 18.7 ± 17.6 months and age of 54.4 ± 25.1 years. All patients underwent lumbar pedicle screw and iliac screw placement. Sacral laminectomy was performed if the patient had a preoperative neurological deficit. Patients were counseled on instrumentation removal at 6-12 months. 67 % of patients sustained a fall, and 33 % were involved in an MVA. 52 % were Roy-Camille Type 2, and 32 % and 20 % were Types 1 and 3, respectively. The mean EBL was 261 ± 400 ml. 37 % required concurrent sacral laminectomy. There were no intraoperative complications and four postoperative complications, including surgical site infection, rod dislodgment, and deep venous thrombosis. 63 % underwent removal of instrumentation after fracture healing. ODI scores significantly improved from 6 weeks post-op (35.5 ± 4.5) to one-year follow-up (18.3 ± 9.6, p = 0.005), two-year follow-up (20.3 ± 10.0, p = 0.03), and final follow-up (16.4 ± 8.8, p = 0.002). Statistically significant improvements were observed in the PROMIS PI, PF, and D domains (p < 0.05). CONCLUSION: Our study demonstrates that lumbopelvic instrumentation leads to successful management of unstable transverse sacral fractures, with improvement in PRO. The combination of percutaneous instrumentation without arthrodesis did not result in any fracture non-union. LEVEL OF EVIDENCE: Level IV.

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Objective To explore how socioeconomic status and patient characteristics may be associated with initial self-reports of pain and determine if there was an increased association with undergoing spine surgery. Methods Patients at an academic center between 2015 and 2021 who completed the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) questionnaire were included. Multivariable linear regression models were used to determine the association between insurance type and patient factors with initial reports of pain. Multivariable logistic regression models were used to determine the association between PI and the likelihood of surgery in two time periods, three and 12 months. Results The study included 9,587 patients. The mean PROMIS-PI scores were 61.93 (SD 7.82) and 63.74 (SD 6.93) in the cervical and lumbar cohorts, respectively. Medicaid and Workers' Compensation insurance patients reported higher pain scores compared to those with private insurance: Medicaid (cervical: 2.77, CI (1.76-3.79), p<0.001; lumbar (2.05, CI (1.52-2.59), p<0.001); Workers' Compensation (cervical: 2.12, CI (0.96-3.27), p<0.001; lumbar: 1.51, CI (0.79-2.23), p<0.001). Black patients reported higher pain compared to White patients (cervical: 1.50, CI (0.44-2.55), p=0.01; lumbar: 1.51, CI (0.94-2.08), p<0.001). Higher PROMIS-PI scores were associated with a higher likelihood of surgery. There was no increased association of likelihood of surgery in Black, Medicaid, or Workers' Compensation patients when controlling for pain severity. Conclusion Black patients and patients with Medicaid and Workers' compensation insurance were likely to report higher pain scores. Higher initial pain scores were associated with an increased likelihood of surgery. However, despite increased pain scores, Black patients and those with Medicaid and Workers' Compensation insurance did not have a higher likelihood of undergoing surgery.

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OBJECTIVE: We aimed to describe spinal biomechanics and injury patterns in rowing. METHODS: In this systematic literature review, a Google and PubMed literature search was undertaken using keywords "rowing," "biomechanics," and "spine." RESULTS: Relevant articles were reviewed and synthesized to describe biomechanics, injury patterns, treatment options, and techniques for injury prevention. CONCLUSIONS: Rowing has increased in popularity throughout the United States. Up-to-date knowledge of rowing biomechanics and spinal injury patterns is necessary for prompt diagnosis and appropriate treatment of the injured rowing athlete.

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Background: Calcium pyrophosphate dihydrate (CPPD) deposition, also known as pseudogout, in the cervical ligamentum flavum (CLF), is a rare disease which can cause spinal cord signaling changes leading to rapid deterioration in function. The natural history of cervical myelopathy as a result of CPPD deposition within the CLF is not well understood. Our objective is to describe the presentation, imaging findings, and treatment options of CPPD deposition or pseudogout of the cervical spine. Methods: Using PubMed, we analyzed studies published from 1978 to 2022. Key words used were "pseudogout," "CPPD deposit disease," "cervical yellow ligament," "CLF," and "cervical spine." We excluded "crowned dense syndrome" and "ossification of ligament flavum." Using a department database, we queried for patients treated for CPPD of the cervical spine. Results: Twenty clinical studies on CPPD of the cervical spine with 69 patients aged between 15 and 92 years (mean = 72) were identified. Neck pain and numbness of the hands were the most common symptoms. Diabetes mellitus and hypertension were the most common comorbidities. Males and females were affected at equal rates. C4-C5 and C5-C6 were the most affected segments. Earlier surgical treatment produced better outcomes. A laminectomy and fusion or laminoplasty were the most common procedures performed with most patients experiencing some return of neurologic function. Conclusion: Although rare, CPPD deposit disease in the CLF should be readily considered as a differential diagnosis due to the continuously aging population. CPPD's progressively worsening nature makes an early diagnosis and treatment important in improving the patient's overall quality of life.

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BACKGROUND: We performed a volume analysis of gravity stress (GS) and simulated weight bearing (WB) CBCT scans of a cadaveric supination external rotation (SER) ankle fracture model. METHODS: An AO supination external rotation 44B3.1 ankle fracture was simulated in 6 human cadavers, each serving as its own control. MCS volume (mm3) was measured on GS and WB CBCT scans. Paired t-tests were used to compare the MCS volume for control versus experimental conditions for GS and WB conditions, and means ± standard deviation are presented. RESULTS: MCS on GS CBCT was greater for the experimental (1,540.15±374.8) versus control (984.5±226.5) groups (P=0.004), and MCS on WB CBCT was also greater for the experimental (1,225.57±274.1) versus control (1,059.40±266.6) groups (P=0.05). MCS on GS CBCT was greater for the experimental group compared to both WB CBCT controls (P=0.005) and WB CBCT experimental group (P=0.04). Additionally, MCS on WB CBCT was greater for the experimental group compared to GS CBCT controls (P=0.002), however there was no statistically significant difference in MCS on GS CBCT for controls versus WB CBCT for controls (P=0.08). CONCLUSIONS: MCS volume increased on WB CBCT scans using a cadaveric SER ankle fracture model.

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BACKGROUND: The utility of computed tomography (CT) for measuring medial clear space (MCS) for determination of the stability of supination external rotation (SER) ankle fractures and in comparison to standard radiographs is unknown. We compared MCS on gravity stress (GS) radiographs to GS and weight bearing (WB) cone-beam CT (CBCT). METHODS: An AO SER 44B3.1 ankle fracture was simulated in 10 human cadavers, also serving as controls. MCS was measured on GS radiographs, GS CBCT, and a simulated WB CBCT scan. Specimens were stable if MCS was <5 mm and unstable if MCS was ≥5 mm. Paired t tests were used to compare MCS from each imaging modality for controls versus SER injuries and stable versus unstable specimens. RESULTS: Compared with controls assessed by GS radiographs, MCS was greater for an SER injury when assessed by GS radiograph and GS CBCT scan within the stable group. Compared with controls assessed by GS radiographs, MCS was greater for SER injuries when assessed by GS radiograph, GS CBCT scan, and WB CBCT within the unstable group. MCS was reduced for stable versus unstable SER injuries assessed by WB CBCT. CONCLUSION: In a cadaveric model of SER ankle fracture, the medial clear space was statistically significantly greater for the experimental condition when assessed by gravity stress radiograph and gravity stress CBCT scan. Under weight-bearing conditions, the cone-beam CT scanner distinguished between stable and unstable ankles in the experimental condition. CLINICAL RELEVANCE: This study suggests that a WB cone-beam CT scan may be able to distinguish between stable and unstable SER ankle fractures and influence operative decision making.

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