{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:15:30Z","timestamp":1788837330904,"version":"build-2803163510"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:p>Sacral fractures are uncommon lesions and most often the result of high-energy trauma. Depending on the fracture location, neurological injury may be present in over 50% of cases. In this article, the authors conducted a comprehensive literature review on the epidemiology of sacral fractures, relevant anatomy of the sacral and pelvic region, common sacral injuries and fractures, classification systems of sacral fractures, and current management strategies. Due to the complex nature of these injuries, surgical management remains a challenge for the attending surgeon. Few large-scale studies have addressed postoperative complications or long-term results, but current evidence suggests that although fusion rates are high, long-term morbidity, such as residual pain and neurological deficits, persists for many patients.<\/jats:p>","DOI":"10.3171\/2014.5.focus1474","type":"journal-article","created":{"date-parts":[[2014,7,1]],"date-time":"2014-07-01T11:06:02Z","timestamp":1404212762000},"page":"E12","source":"Crossref","is-referenced-by-count":67,"title":["Sacral fractures"],"prefix":"10.3171","volume":"37","author":[{"given":"Mohamad","family":"Bydon","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vance","family":"Fredrickson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"De la Garza-Ramos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald A.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory R.","family":"Trost","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"S80","article-title":"Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability","volume":"31","author":"Bellabarba","year":"2006"},{"key":"b2-focus1474","series-title":"Spine Surgery: Techniques, Complication Avoidance, and Management","author":"Benzel","year":"2012"},{"key":"b3-focus1474","series-title":"Med World","first-page":"140","article-title":"Sacral fractures and cauda equina lesions","volume":"67","author":"Bonnin","year":"1947"},{"key":"b4-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"817","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"key":"b5-focus1474","series-title":"Clin Orthop Relat Res","first-page":"67","article-title":"Sacral fractures: an important problem. Retrospective analysis of 236 cases","volume":"227","author":"Denis","year":"1988"},{"key":"b6-focus1474","series-title":"J Bone Joint Surg Am","first-page":"486","article-title":"Transverse fractures of the sacrum. A report of six cases","volume":"59","author":"Fountain","year":"1977"},{"key":"b7-focus1474","series-title":"J Bone Joint Surg Br","first-page":"882","article-title":"Sacral insufficiency fractures in the elderly","volume":"76","author":"Gotis-Graham","year":"1994"},{"key":"b8-focus1474","series-title":"Arch Intern Med","first-page":"668","article-title":"Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women","volume":"156","author":"Grasland","year":"1996"},{"key":"b9-focus1474","series-title":"Orthopedics","first-page":"752","article-title":"Sacral fractures: current strategies in diagnosis and management","volume":"32","author":"Hak","year":"2009"},{"key":"b10-focus1474","series-title":"J Orthop Trauma","first-page":"163","article-title":"Classification of sacral fractures based on CT imaging","volume":"3","author":"Kaehr","year":"1989"},{"key":"b11-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"1047","article-title":"Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group","volume":"31","author":"Kuklo","year":"2006"},{"key":"b12-focus1474","series-title":"Spine J","first-page":"612","article-title":"A new classification for complex lumbosacral injuries","volume":"12","author":"Lehman","year":"2012"},{"key":"b13-focus1474","series-title":"Operative Tech Orthop","first-page":"221","article-title":"Fixation of fractures of the sacrum","volume":"7","author":"Levine","year":"1997"},{"key":"b14-focus1474","series-title":"Skeletal Trauma: Basic Science, Management and Reconstruction","first-page":"1079","article-title":"Fractures of the sacrum","volume":"1","author":"Levine","year":"2009"},{"key":"b15-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"630","article-title":"Bilateral facet dislocations in the thoracolumbar spine","volume":"13","author":"Levine","year":"1988"},{"key":"b16-focus1474","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"100","article-title":"Fractures of the sacrum: their incidence in fractures of the pelvis","volume":"42","author":"Medelman","year":"1939"},{"key":"b17-focus1474","series-title":"J Am Acad Orthop Surg","first-page":"656","article-title":"Sacral fractures","volume":"14","author":"Mehta","year":"2006"},{"key":"b18-focus1474","series-title":"Int J Radiat Oncol Biol Phys","first-page":"61","article-title":"Pelvic insufficiency fractures in patients with pelvic irradiation","volume":"44","author":"Moreno","year":"1999"},{"key":"b19-focus1474","series-title":"Clin Imaging","first-page":"92","article-title":"Sacral insufficiency fractures. Spectrum of radiological features","volume":"19","author":"Peh","year":"1995"},{"key":"b20-focus1474","series-title":"Youmans Neurological Surgery","first-page":"3250","article-title":"Sacral fractures","volume":"3","author":"Perin","year":"2011"},{"key":"b21-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"838","article-title":"Transverse fracture of the upper sacrum. Suicidal jumper's fracture","volume":"10","author":"Roy-Camille","year":"1985"},{"key":"b22-focus1474","series-title":"J Trauma","first-page":"1113","article-title":"Sacral fractures: classification and neurologic implications","volume":"26","author":"Sabiston","year":"1986"},{"key":"b23-focus1474","series-title":"Neurosurgery","first-page":"735","article-title":"Sacral fractures","volume":"15","author":"Schmidek","year":"1984"},{"key":"b24-focus1474","series-title":"J Orthop Trauma","first-page":"297","article-title":"Functional outcomes of Denis zone III sacral fractures treated nonoperatively","volume":"24","author":"Siebler","year":"2010"},{"key":"b25-focus1474","series-title":"J Orthop Trauma","first-page":"200","article-title":"An unusual type of fracture in the upper sacrum","volume":"5","author":"Strange-Vognsen","year":"1991"},{"key":"b26-focus1474","series-title":"Interact Cardiovasc Thorac Surg","first-page":"515","article-title":"Bilateral iliac artery dissection following severe complex unstable pelvic fracture","volume":"7","author":"Teebken","year":"2008"},{"key":"b27-focus1474","series-title":"Int Orthop","first-page":"244","article-title":"Sacral fractures with neurological injury: is early decompression beneficial?","volume":"28","author":"Zelle","year":"2004"},{"key":"b1-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"S80","article-title":"Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability","volume":"31","author":"Bellabarba","year":"2006"},{"key":"b2-focus1474","series-title":"Spine Surgery: Techniques, Complication Avoidance, and Management","author":"Benzel","year":"2012"},{"key":"b3-focus1474","series-title":"Med World","first-page":"140","article-title":"Sacral fractures and cauda equina lesions","volume":"67","author":"Bonnin","year":"1947"},{"key":"b4-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"817","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"key":"b5-focus1474","series-title":"Clin Orthop Relat Res","first-page":"67","article-title":"Sacral fractures: an important problem. Retrospective analysis of 236 cases","volume":"227","author":"Denis","year":"1988"},{"key":"b6-focus1474","series-title":"J Bone Joint Surg Am","first-page":"486","article-title":"Transverse fractures of the sacrum. A report of six cases","volume":"59","author":"Fountain","year":"1977"},{"key":"b7-focus1474","series-title":"J Bone Joint Surg Br","first-page":"882","article-title":"Sacral insufficiency fractures in the elderly","volume":"76","author":"Gotis-Graham","year":"1994"},{"key":"b8-focus1474","series-title":"Arch Intern Med","first-page":"668","article-title":"Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women","volume":"156","author":"Grasland","year":"1996"},{"key":"b9-focus1474","series-title":"Orthopedics","first-page":"752","article-title":"Sacral fractures: current strategies in diagnosis and management","volume":"32","author":"Hak","year":"2009"},{"key":"b10-focus1474","series-title":"J Orthop Trauma","first-page":"163","article-title":"Classification of sacral fractures based on CT imaging","volume":"3","author":"Kaehr","year":"1989"},{"key":"b11-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"1047","article-title":"Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group","volume":"31","author":"Kuklo","year":"2006"},{"key":"b12-focus1474","series-title":"Spine J","first-page":"612","article-title":"A new classification for complex lumbosacral injuries","volume":"12","author":"Lehman","year":"2012"},{"key":"b13-focus1474","series-title":"Operative Tech Orthop","first-page":"221","article-title":"Fixation of fractures of the sacrum","volume":"7","author":"Levine","year":"1997"},{"key":"b14-focus1474","series-title":"Skeletal Trauma: Basic Science, Management and Reconstruction","first-page":"1079","article-title":"Fractures of the sacrum","volume":"1","author":"Levine","year":"2009"},{"key":"b15-focus1474","series-title":"Spine (Phila Pa 1976)","first-page":"630","article-title":"Bilateral facet dislocations in the thoracolumbar spine","volume":"13","author":"Levine","year":"1988"},{"key":"b16-focus1474","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"100","article-title":"Fractures of the sacrum: their incidence in fractures of the pelvis","volume":"42","author":"Medelman","year":"1939"},{"key":"b17-focus1474","series-title":"J Am Acad Orthop Surg","first-page":"656","article-title":"Sacral fractures","volume":"14","author":"Mehta","year":"2006"},{"key":"b18-focus1474","series-title":"Int J Radiat Oncol Biol Phys","first-page":"61","article-title":"Pelvic insufficiency fractures in patients with pelvic irradiation","volume":"44","author":"Moreno","year":"1999"},{"key":"b19-focus1474","series-title":"Clin Imaging","first-page":"92","article-title":"Sacral insufficiency fractures. 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