Table 1 Statement supported by the consensus

DIAGNOSTIC PROTOCOL

1. In case a complete neurological examination (e.g. intubated polytraumatized patient) can’t be performed, pelvic Xray are useful

2. In case a complete neurological examination (e.g. intubated polytraumatized patient) can’t be performed, CT scan is useful

3. In case a complete neurological examination (e.g. intubated polytraumatized patient) can’t be performed, hip and pelvis MRI is useful

4. In case a complete neurological examination (e.g. intubated polytraumatized patient) can’t be performed, Lumbosacral MRI is useful

5. In case a complete neurological examination (e.g. intubated polytraumatized patient) can’t be performed, Lumbosacral Evoked lower extremities potentials are useful

6. Lower extremities EMG should be not used in an acute setting

TREATMENT AND TIMING IN PATIENT WITH CAUDA EQUINA SYNDROME

7. In a patient with cauda equina syndrome (lower extremities neurological deficit, erectile dysfunction, urinary retention/urinary or fecal incontinence and saddle anaesthesia) associated with a sacral fracture represents an absolute indication to sacral reduction and fixation

8. In a patient with cauda equina syndrome (lower extremities neurological deficit, erectile dysfunction, urinary retention/urinary or fecal incontinence and saddle anaesthesia) associated with a sacral fracture, the correct timing for reduction and fixation is “as early as possible”

TREATMENT IN PATIENT WITH HIGH ENERGY TRAUMA

9. An isolated and complete radicular neurological deficit of the lower limbs does not represent an indication to laminectomy after reduction in case of a displaced sacral fracture in a high energy trauma associated with an imaging suggestive of root compression

10. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an indication to laminectomy after reduction in case of a displaced sacral fracture in a high energy trauma associated with an imaging suggestive of root compression

11. Worsening and progressive radicular neurological deficit of the lower limbs represents an indication to laminectomy after reduction in case of a displaced sacral fracture in a high energy trauma associated with an imaging suggestive of root compression

12. In case of a displaced sacral fracture and neurological deficit with an imaging showing no evidence of nerve root compression, a laminectomy after reduction is not be indicated

TREATMENT IN PATIENT WITH LATE DIAGNOSIS

13. In a patient who was not initially investigated from a neurological point of view (neither physical examination nor imaging), due to the general conditions, clinical investigation after 72 hours identifies a neurological deficit in presence of a displaced sacral fracture with nerve compression on MRI, a laminectomy after reduction is indicated

SURGICAL TECHNIQUE

14. In case of indication to perform a sacral decompression, a first attempt with closed reduction through external manoeuvres is not mandatory

15. Transcondylar traction does not represent a valid method of closed decompression in unstable unilateral pelvic fractures and vertical shear type fractures

16. Following a sacral decompression, should a sacral fixation (e.g. sacroiliac screw, triangular osteosynthesis, lumbopelvic fixation) be performed

TREATMENT IN PATIENT WITH LOW ENERGY TRAUMA

17. An isolated and complete radicular neurological deficit of the lower limbs represents an absolute indication to laminectomy after reduction in case of a displaced sacral fracture in a low energy trauma associated with an imaging suggestive of root compression

18. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an absolute indication to laminectomy after reduction in case of a displaced sacral fracture in a low energy trauma associated with an imaging suggestive of root compression

19. Worsening and progressive radicular neurological deficit of the lower limbs represents an indication to laminectomy after reduction in case of a displaced sacral fracture in a low energy trauma associated with an imaging suggestive of root compression

20. In case of a displaced sacral fracture and neurological deficit in a low energy trauma, surgical fixation after performing a sacral decompression is indicated