Debilitating sciatica following a sacral fracture
A case report
Keywords:sacral spine, sacral fracture, sciatica, surgery for sacral fractures
Following a horse-riding accident, a 16-year-old female sustained a minimally displaced sacral fracture extending into the S1 and S2 foramina on the left. The patient was initially treated conservatively but neuropathic pain, dysaesthesia and weakness in the L5 and S1 distributions developed and persisted. CT and MRI revealed a fracture fragment abutting the L5 nerve root. Epidural anaesthesia and aggressive neural mobilisation by physiotherapy failed to improve symptoms.
Surgical decompression via the sub-iliacus approach was then performed 6 weeks following the injury. Symptoms resolved immediately but recurred in the L5 distribution, presumably due to neuritis, and were successfully managed conservatively. Six weeks following surgery, all symptoms had resolved and the patient mobilised independently and returned to her pre-injury level of activity.