Sacral and Lumbar Injuries: Treatment Options After a Car Accident

Decreased sacral and coccygeal curvature, S3 fracture, L5/S1 disc space narrowing, pubic symphysis diastasis?

Dear Dr.
Zhan,
I am currently working in Southeast Asia and had a car accident two weeks ago, resulting in ruptures of my liver and spleen.
I underwent transarterial embolization (TAE) treatment and am currently stable with no major issues with my liver and spleen.
However, my bone injuries are more severe, as I am unable to sit up or stand.
In the past two days, I have attempted rehabilitation using a walker, and I can stand for a maximum of 10 minutes.
During the use of the walker, I experience significant numbness in my sacrum and coccyx, while my arms have strength, but my legs do not.
The local doctors are not providing aggressive therapies such as hydrotherapy or bone cement treatments.
My case is being managed conservatively, with only oral medications (pain relievers, anti-inflammatories, calcium supplements, etc.) provided, and I have been advised to rest in bed for 3 to 6 months.
Below are the X-ray and CT diagnostic reports (presented in original text to avoid translation errors):
- Fracture S3 noted.
- Separation of the pubic symphysis noted.
- Reduced curvature noted.
- Severe disc space narrowing at the L5/S1 level.
- Vertebral heights are preserved.
- Subarticular sclerosis with marginal osteophytes noted.
- No spondylolisthesis changes noted.
- Degenerative changes along the facet joint.
Impression:
(1) Fracture S3 noted.
(2) Separation of the pubic symphysis noted.
(3) Mild spondylosis changes and disc degeneration at the L5/S1 level.
Regarding the separation of the pubic symphysis, I am currently using a lumbar support belt for treatment.
However, for the sacrum and coccyx, the local doctors have advised that I can only lie in bed for 3 to 6 months.
I would like to inquire if there are more aggressive and effective treatment options available.
If you believe that returning to Taiwan would allow for better and more proactive treatment than what I am currently receiving, I am considering giving up my job to return to Taiwan for treatment.
Thank you for your valuable advice!
Sincerely,
Bruce

Bruce, 30~39 year old female. Ask Date: 2021/01/13

Dr. Zhan Xian reply Orthopedics

Hello Mr.
Bruce, whether surgical treatment for the pelvis is necessary mainly depends on the stability of the pelvic fracture.
Since we only have a written report without imaging, it is difficult to assess the extent of the pubic symphysis separation and whether there is any displacement of the sacral fracture.
The report also indicates that there is narrowing of the intervertebral disc space between the fifth lumbar vertebra and the first sacral vertebra, which may affect lower limb mobility.
At this point, we cannot determine if surgery is required.
If you are flying back to Taiwan, please discuss this matter carefully with your family and local physicians, considering the risks associated with the pandemic and the potential for liver and spleen rupture.

Reply Date: 2021/01/13

More Info

Dear Bruce,
Thank you for sharing your situation regarding your recent car accident and the subsequent injuries you have sustained. It sounds like you have been through a very challenging time, and I commend your determination to seek the best possible treatment for your condition.
Based on the details you've provided, including the X-ray and CT findings, it appears that you have sustained significant injuries, particularly to the sacral region (S3 fracture), the pubic symphysis, and the lumbar spine (L5/S1 disc space narrowing). These injuries can lead to considerable pain and functional limitations, as you have experienced.

Treatment Options
1. Conservative Management: As you mentioned, your current treatment plan involves conservative management, which typically includes rest, pain management with medications (analgesics and anti-inflammatories), and possibly physical therapy. While this approach is essential, it may not be sufficient given the severity of your injuries.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can guide you through exercises tailored to your condition, focusing on strengthening the muscles around your spine and pelvis, improving flexibility, and enhancing your overall mobility. This can help alleviate some of the pain and improve your ability to stand and walk.

3. Pain Management: If oral medications are not providing adequate relief, you might consider discussing other pain management options with your healthcare provider. This could include nerve blocks, epidural steroid injections, or other interventional pain management techniques that can provide more targeted relief.

4. Surgical Options: Given the nature of your injuries, particularly the S3 fracture and the significant disc space narrowing at L5/S1, surgical intervention may be warranted if conservative measures fail to provide relief or if there is a risk of further complications. Surgical options could include spinal fusion or stabilization procedures, which can help restore alignment and reduce pain.

5. Alternative Therapies: While you mentioned that local doctors are not performing more aggressive therapies, you might want to explore options such as acupuncture, chiropractic care, or other complementary therapies that some patients find beneficial for pain relief and mobility improvement.

6. Rehabilitation Programs: If you are considering returning to Taiwan for treatment, look for rehabilitation centers that specialize in post-trauma recovery. These facilities often have multidisciplinary teams that can provide comprehensive care, including orthopedic specialists, physiatrists, and physical therapists.

Conclusion
In summary, while your current conservative treatment plan is a necessary first step, it may be beneficial to explore more aggressive treatment options, especially if you are experiencing significant limitations in your daily activities. If you feel that the care you are receiving locally is not meeting your needs, returning to Taiwan for a more comprehensive evaluation and treatment plan could be a wise decision.

Please ensure that you have open communication with your healthcare providers about your symptoms and treatment goals. They can help you navigate your options and make informed decisions about your care.
Wishing you a smooth recovery and the best of luck with your treatment journey.

Sincerely,
Doctor Q&A Teams

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