Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group

Study Design. Literature review. Objectives. Members of the Spine Trauma Study Group evaluated various imaging methods and compiled standardized approaches to making radiographic measurements for the assessment of sacral fractures. Summary of Background Data. The diagnosis of sacral fractures is frequently missed or delayed, and the treatment is controversial, with significant variations in recommendations regarding nonoperative treatment, neural decompression, and internal fixation. A paucity of specific radiographic measurements and criteria exist to aid the clinician in making sound treatment decisions. This may obligate surgeons to base clinical decisions on nonstandardized, nonvalidated recommendations and measures and, in some cases, anecdotal evidence. We think that a critical first step toward valid and optimal clinical decision-making requires an accurate and clear definition of imaging measurement parameters used to evaluate sacral injuries and gather data for future studies. Methods. A review of the English-speaking literature was performed to assess cited radiographic measurement techniques of sacral fractures currently in use. This allowed the formulation of detailed radiographic assessments designed to more reliably describe sacral fracture morphometry. Results. These measurements include: anterior-posterior sacral fracture displacement (axial computed tomography [CT] of the pelvis), vertical sacral fracture displacement (coronal CT reconstruction), anterior-posterior translation and kyphotic angulation (sagittal CT reconstructions), and degree of central canal involvement and foraminal encroachment (axial CT with fine cuts and coronal and sagittal reconstructions). Other radiographic factors that should be considered that may impact treatment outcomes include the level and type of sacral fracture, lumbosacral junction and sacroiliac joint involvement, and associated pelvic ring injury. Conclusions. With adoption of these radiographic guidelines, future studies will have a uniform method in which to describe sacral injuries and therefore allow study of the efficacy of various recommended treatment protocols.