Sacral Fractures and Disc Narrowing After Trauma

Decreased curvature of the sacrococcygeal region, S3 fracture, L5/S1 disc space narrowing, and pubic symphysis diastasis?

Dear Dr.
Zhan,
Thank you very much for your response.
It has been 20 days since the car accident on December 28, 2020.
Two days after the incident, I underwent transarterial embolization (TAE) for my liver, and a check-up ten days ago confirmed that there is no bleeding from the liver (2 cm injury) and spleen (0.7 cm injury).
Currently, both the liver and spleen are stable.

My main concern now is the bone issues, including the previously mentioned "S3 fracture," "L5/S1 disc space narrowing," and "pubic symphysis separation (approximately 1.8 cm)." After 20 days of rest (initially, I could only lie in bed), I can now sit up independently, stand with the strength of my arms and legs, and slowly move around the house using a walker.
However, I still need to sit on a soft cushion, as sitting for long periods causes pressure on my coccyx and sacrum.
I also cannot stand for long due to insufficient strength related to my coccyx and sacrum.
I hope to return to normal life through the most proactive treatment possible.
If there are better treatment options for my condition, I would like to return to Taiwan for treatment.
However, if there are no better options, due to work commitments and my spouse expecting to give birth locally in May, the timing of my return remains uncertain due to local lockdown issues.
Therefore, I need to understand the situation regarding treatment and personal matters to make informed decisions.
All the symptoms mentioned have imaging/photos available, but I am unable to provide them through this platform.
Would it be possible to send them to you via email or another method for your reference? Currently, I am in Myanmar, where medical facilities are underdeveloped, and I hope to better understand my condition and explore options beyond conservative treatment.
Thank you for your understanding!
Sincerely,
Bruce
____________________________
Below are the X-ray and CT diagnostic reports (presented in original text to avoid translation errors):
- Fracture S3 noted.

- Separation of pubic symphysis noted.

- Reduced curvature noted.

- Severe disc space narrowing at L5/S1 level.

- Vertebral height is 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 pubic symphysis noted.

(3) Mild spondylosis changes and PID at L5/S1 level.

Regarding the pubic symphysis separation, I am currently using a lumbar support belt for treatment, but for the sacrum and coccyx, the local doctor has advised that I can only lie in bed for 3-6 months.

Bruce, 30~39 year old female. Ask Date: 2021/01/17

Dr. Zhan Xian reply Orthopedics

Mr.
Bruce, if the pubic symphysis is separated by 1.8 cm and the pelvic structure is stable, conservative treatment is possible.
Your injury requires time to heal, so please take a gradual approach and do not rush.
Walking too much at the beginning may actually hinder bone healing.

Reply Date: 2021/01/17

More Info

Understanding sacral fractures and disc narrowing after trauma is crucial for effective management and rehabilitation. Sacral fractures, particularly those involving the S3 vertebra, can result from significant trauma, such as in your case of a car accident. These fractures can lead to various complications, including pain, instability, and potential neurological deficits depending on the severity and location of the injury.

The sacrum is a triangular bone at the base of the spine, and it plays a vital role in weight-bearing and stability. An S3 fracture can disrupt the normal biomechanics of the pelvis and lower back, leading to pain and functional limitations. The separation of the pubic symphysis, as noted in your reports, further complicates the situation, as it can affect pelvic stability and contribute to discomfort during movement.

The narrowing of the disc space at the L5/S1 level indicates degenerative changes, which can be exacerbated by trauma. Disc narrowing can lead to increased pressure on the surrounding structures, including nerves, potentially causing pain and mobility issues. The presence of marginal osteophytes and subarticular sclerosis suggests that there are ongoing degenerative changes in the lumbar spine, which may require careful monitoring and management.

In your case, the recommendation to use a lumbar support belt is appropriate, as it can help stabilize the lumbar region and reduce pain during the healing process. However, the advice to remain in bed for an extended period (3-6 months) may not be ideal for everyone. Prolonged immobilization can lead to muscle atrophy, decreased bone density, and other complications. It is essential to balance rest with gradual mobilization to promote healing and maintain function.

Given your current situation, where you are able to sit up and use a walker, it is crucial to continue progressing in your rehabilitation. Engaging in gentle range-of-motion exercises, as tolerated, can help maintain joint mobility and prevent stiffness. Physical therapy may also be beneficial, focusing on strengthening the core and pelvic muscles to support the spine and pelvis.

If you are considering returning to Taiwan for further treatment, it would be wise to consult with a specialist in orthopedic trauma or a rehabilitation physician. They can provide a comprehensive evaluation and tailor a treatment plan that addresses your specific needs. Options may include advanced imaging to assess the healing of your fractures, pain management strategies, and possibly surgical interventions if conservative measures do not yield satisfactory results.

In summary, while your current treatment focuses on rest and support, it is essential to remain proactive in your recovery. Regular follow-ups with healthcare providers, whether in Myanmar or Taiwan, will help ensure that you receive the best possible care. As you navigate this challenging period, maintaining open communication with your medical team and advocating for your health will be key to achieving a successful recovery.

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