Stepladder Pattern Transverse Sacral Fracture: A Previously Unreported Morphology With Neurological Recovery.

CASE: A 25-year-old man presented with cauda equina syndrome after a fall from height. Imaging revealed an isolated transverse sacral fracture with contiguous S1 to S4 fracture lines, creating a distinctive "stepladder" morphology without significant canal compromise. The fracture was managed conservatively. Neurological status improved from ASIA Grade C to D, with recovery of perianal sensation and bladder function. At 12 months, the patient demonstrated clinical recovery, with improved functional outcome.

CONCLUSION: This unique "stepladder pattern" transverse sacral fracture demonstrated excellent neurological recovery with conservative management in selected patients without progressive deficits.