Spinal injuries affecting the lumbosacral spine and pelvis

Lumbo-sacral fractures are complex injuries that often occur alongside pelvic ring trauma. They are often missed on initial assessment and plain radiography, and delayed treatment can lead to pain, reduced mobility and neurological compromise. Careful clinical examination is essential and identification of the fracture pattern often requires CT imaging. A large number of classification systems are available to help guide decision-making and these have recently been summarised in the comprehensive AO Spine sacral fracture classification system. Surgical intervention includes both neurological decompression and stabilisation and is indicated for patients with neurological compromise, lumbo-sacral instability and significant soft tissue injuries.