A case report of a U-type sacral fracture, or spinopelvic dissociation, resulting from chiropractic manipulation has recently been published. It presents the case of a 74-year-old male patient who sustained a U-type sacral fracture after drop-table chiropractic manipulation.
The recent case of a spinopelvic dissociation demonstrates that chiropractic manipulative therapy involving the commonly used drop-table can cause severe injury. The patient’s course was complicated by a delay in diagnosis and a prolonged hospital stay. Orthopaedic surgeons should have a high degree of suspicion for spinopelvic dissociation in the setting of bilateral sacral fractures. One year after injury, with conservative management, the patient returned to baseline function with mild residual neuropathy.
Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When spinopelvic dissociation is expediently identified and treated appropriately, patient outcomes can be maximized, highlighting the importance of early diagnosis and treatment. Because of its rarity and complexity, there remains a paucity of high-level evidence-based guidance on treating this complex issue. Most cases are caused by a fall from heights, followed by road accidents. Many patients show neurologic impairment at initial presentation, which often improves after surgery, the treatment of choice.