546 J. Neurosurg: Spine / Volume 5 / December, 2006 RANSVERSE sacral fractures are uncommon sacral fractures and occur in 2 to 5% of total sacral frac- tures. 3,8 They are caused by falls and pedestrian or passenger motor vehicle accidents. 4,6,8,10,12,21,23,25 They have been classified by Roy-Camille, et al., 15 and by Strange- Vognsen and Lebech. 20 We report a rare case in which the TSF was sustained during a PWC accident and in which the patient under- went early surgery. Case Report History. This 23-year-old woman on vacation was rid- ing a PWC in the ocean, jumped a wave, lost control of the vehicle, fell backward, and struck her lower back on the vehicle. She experienced severe pain and difficulty mov- ing her legs. After being taken to the shore she was brought to the hospital. Examination. The patient’s only complaint was severe low-back pain. Her vital signs were normal. Neurologi- cally she was alert and oriented, and examination of cra- nial nerve function demonstrated intact responses. We ob- served normal upper- and lower-extremity strength, sensation, and reflexes. Initially the patient’s genital and perineal areas were not examined neurologically. The sa- cral region was extremely painful to palpation; inspection revealed an area of ecchymosis in the sacral region. Analgesic agents were administered. Plain lateral radio- graphy showed a sacral angulated fracture located be- tween S-2 and S-3 (Fig. 1). Because of the radiographic findings, a CT scan was obtained, and neurological exam- ination was repeated, this time focusing on the function of the sacral nerve roots. The patient’s lumbosacral pain had improved. The S-1 motor and sensation functions were normal, saddle anesthesia was present, perianal sensation and anocutaneous reflex were absent, and rectal tone was poor. To evaluate bladder control, a bolus of saline solu- tion was administered intravenously and the patient was not able to void her bladder, instead exhibiting urinary retention; the bladder was catheterized. Axial CT scanning revealed a depressed laminar S2–3 fracture with significant narrowing of the sacral canal (Fig. 2); on a sagittal CT reconstruction (Fig. 3) we ob- served mild sacral angulation and significant sacral canal stenosis caused posteriorly by the depressed laminar frac- ture. Because of the degree of canal narrowing and clinical findings and because the patient’s condition was optimal for surgery, we decided that the best treatment option was decompression of the sacral nerve roots. Operation. The patient underwent surgery 5 hours after sustaining the injury. After the fracture site was identified on fluoroscopy, decompression was performed. The de- pressed bone fragments of laminae were excised; we could see the termination of the thecal sac, but it was not compressed. The nerve roots beneath the fracture were edematous and hyperemic, whereas the dura mater cover- ing these roots was intact. The nerve roots were de- compressed. Postoperative Course. The day after the surgery, the pa- tient’s urinary catheter was kept closed. The patient expe- rienced sensation during micturition 24 hours after the J Neurosurg Spine 5:546–549, 2006 An unusual transverse sacral fracture treated with early decompression Case report LUIS A. ROBLES, M.D., AND EDGAR PLANTILLAS, M.D. Department of Neurosurgery, Hospital Medasist, Puerto Vallarta; and Department of Orthopedics, Hospital General de San Francisco, San Francisco Nayarit, Mexico The authors describe the case of a patient who sustained a transverse sacral fracture (TSF) associated with a de- pressed laminar fracture in a personal watercraft accident. The patient underwent early surgery, which allowed a quick recovery. To the best of the authors’ knowledge, the mechanism of injury and type of fracture have not been previ- ously described or classified in cases of TSF. KEY WORDS • fracture • sacrum • decompression surgery T Abbreviations used in this paper: CT = computed tomography; PWC = personal watercraft; TSF = transverse sacral fracture.