• Michita Noma, Yusuke Sato, Nobuhiro Hara, Jim Yu, Hiroki Fukuhara, Masayoshi Fukushima, Mitsuhiro Nishizawa, Naoto Komatsu, and Yasushi Oshima.
• Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan; Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
• World Neurosurg. 2024 Aug 1; 188: e278e287e278-e287.

BackgroundSacral fractures can cause lower urinary tract symptoms (LUTS) due to damage to the cauda equina. While several studies have reported on sacral fractures due to high-energy trauma, those due to fragility fractures have only been reported in case reports and their clinical differences are not well known. This study aimed to investigate the clinical characteristics of LUTS caused by fragility sacral fractures and propose a novel treatment strategy.MethodsThis study is retrospective, uncontrolled, clinical case series. The inclusion criteria were sole sacral fractures due to low-energy trauma and appearance of LUTS after injury. Patients with additional spinal fractures or combined abdominal or pelvic organ injuries that could cause LUTS were excluded. Improvement in LUTS, period from onset to improvement, and imaging findings were recorded.ResultsEight patients met the inclusion criteria (4 surgical and 4 conservative treatment cases). Six patients showed improvement in LUTS. In surgical cases, the mean period from onset of LUTS to surgery and from onset of LUTS to improvement was 14.5 and 21.5 days, respectively. Intraoperative rupture or laceration of the dural sac was not observed. In 2 conservatively improved cases, the period from onset to improvement of LUTS was 14 and 17 days.ConclusionsLUTS can improve even with conservative treatment and should be utilized as the primary choice. LUTS caused by severe sacral canal deformity and stenosis can be reversible, and the decision to perform surgical treatment is still timely if LUTS do not improve with conservative treatment for several weeks.Copyright © 2024 Elsevier Inc. All rights reserved.

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