الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
SUMMARY
The sacrum is a keystone structure that is important to the structural integrity of the base of the spinal column and posterior pelvic ring. Therefore, depending on the fracture pattern, fracture of the sacrum may have implications on posterior pelvic or spinopelvic stability.
Sacral fracture classifications are based on fracture location, pattern of instability, and risk of neurologic deficits. Sacral fractures have emerged from relatively underappreciated entities to injuries whose optimal treatment is recognized to have profound consequences on the patient’s functional outcome.
Advances in diagnostic imaging continue to provide additional insights into the structural and neurologic aspects of the injured sacrum, allowing comprehensive injury assessment even in the cognitively impaired and poly-traumatized patient. In cases of neurologic deficit, excessive mal-alignment or instability, surgical intervention involves neurologic decompression, fracture realignment, and surgical fixation in order to optimize long-term outcomes.
The timing of surgical intervention is determined by several factors, including the patient’s associated injuries, overall physiologic condition, and the presence of neurologic deficits, open fractures, or soft tissue compromise that places skin at risk of necrosis.
Surgical options continue to expand as new stabilization methods and implants are developed. Surgeons now have a wide spectrum of procedures at their disposal, ranging from minimally invasive to comprehensive stabilization techniques.
Many issues concerning evaluation and treatment remain controversial and, in the absence of comparative treatment trials, conclusions are currently based largely on subjective reports and observations. The benefits of any proposed treatment need to be weighed carefully against the potential risks and must be individualized to the patient and specific injury.
Treatment decisions continue to be based on a substantial degree of intuition and foresight gained from experience.
The challenge to the spine surgeon remains to implement the available resources effectively as our understanding of the pathophysiology of these injuries grows.