Traumatic Complete Lateral Dislocation at the Lumbosacral Junction

Arandi, Navid R.; Kabirian, Nima; Zhang, Dongke; Schroerlucke, Samuel R.

doi:10.1097/bsd.0000000000000084

Cited by 12 publications

(10 citation statements)

References 27 publications

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“…The sequential evaluation and use of multi-modality imaging modalities help diagnose these complex injuries [5]. Recent literature reports that a majority of these injuries result in an anterior dissociation of the lumbosacral joint, with posterior dissociation and lateral dissociation being among the least common [4,[12][13][14][15]. The management of TLSD is typically a complex and multifactorial effort because of the multisystem involvement including injury to major vessels and abdominal and spinal injury.…”

Section: Discussionmentioning

confidence: 99%

Combined Posterior-Anterior Interbody Fusion in the Management of Traumatic Lumbosacral Dissociation: A Case Report and Review of Literature

Scott

Arias

Tavanaiepour

et al. 2020

Cureus

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Traumatic lumbosacral dissociation is a unique, but well-documented, phenomenon that generally stems from high-energy impact injuries to the lower lumbar spine. Patients typically present with complicated and multisystem injuries with wide-ranging neurological deficits below the level of trauma. This presents stark challenges regarding the diagnosis, management, and surgical correction technique utilized. In this study, we present the case of a 21-year-old, morbidly obese, male patient that presented after a traumatic motor vehicle accident with L5-S1 lumbosacroiliac dissociation, cauda equina syndrome, and left lower extremity monoplegia. The degree of disruption warranted a 360° approach, we opted for an anterior lumbar interbody fusion followed by a posterior, lumbar interbody, short segment fusion. We review the case and relevant literature of similar lumbosacral dissociation studies with their management options and outcomes. Due to the rare nature of these devastating injuries, there remains wide variability in their management, with a combination of open anterior and posterior approaches resulting in variable long-term outcomes. The management of these rare injuries will require appropriate consideration of the patient's unique etiology, coexisting injuries, and radiological imaging in deciding surgical stabilization techniques.

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Section: Discussionmentioning

confidence: 99%

Combined Posterior-Anterior Interbody Fusion in the Management of Traumatic Lumbosacral Dissociation: A Case Report and Review of Literature

Scott

Arias

Tavanaiepour

et al. 2020

Cureus

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“…Shen et al reported that 10% of reported lumbosacral fracture dislocations were not initially recognized, though these were in patients where X-ray was the primary imaging modality [ 36 ]. Clinical presentation varies widely, [ 59 – 78 ] and may include severe lower back pain with exam findings such as flank hematomas, abrasions or palpable step-offs of the spinous processes.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…Aihara et al reported a 68.4% rate of neurologic deficit in 57 cases [ 1 ], while only 3 out of 11 patients (27.3%) in the series by Vialle et al demonstrated neurological injury [ 58 ]. Grivas et al reported a 58% rate of neurologic deficit for all lumbosacral fracture dislocations [ 2 ], while Arandi et al found an 89% rate of neurological injury for complete lumbosacral dislocations [ 59 ].…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…Acute lumbosacral dislocations are unstable, and a growing body of literature recommends early surgical reduction with instrumentation [ 1 , 59 , 71 , 81 , 92 , 97 , 98 ]. Historic techniques for instrumentation have included a wide range of constructs including interspinous screws, posterior articular screws, sublaminar wiring, Harrington hooks and rods, and osteosynthesis with posterior plates or with Cotrel-Dubousset-type instrumentation [ 23 , 25 , 27 , 30 , 40 , 54 , 64 , 84 , 99 – 104 ].…”

Section: Managementmentioning

confidence: 99%

“…All dislocation injuries should also be treated with fusion. While there is little literature describing the superiority of one fusion method over another, options include posterior arthrodesis [ 1 , 59 ], circumferential arthrodesis [ 27 , 70 , 72 ], and interbody fusion, which is often used in cases of significant disc disruption [ 24 , 64 , 99 ]. Partial facetectomy may be performed in patients with traumatic lumbosacral dislocation to facilitate reduction [ 34 , 46 , 70 , 85 , 99 ], although intact apophyseal joints are preferred to prevent redislocation [ 34 ].…”

Section: Managementmentioning

confidence: 99%

See 2 more Smart Citations

Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Moon¹,

Ateşok²,

Niemeier³

et al. 2018

Advances in Orthopedics

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Traumatic lumbosacral dislocation is a rare, high-energy mechanism injury characterized by displacement of the fifth lumbar vertebra in relation to the sacrum. Due to the violent trauma typically associated with this lesion, there are often severe, coexisting injuries. High-quality radiographic studies, in addition to appropriate utilization of CT scan and MRI, are essential for proper evaluation and diagnosis. Although reports in the literature include nonoperative and operative management, most authors advocate for surgical treatment with open reduction and decompression with instrumentation and fusion. Despite advances in early diagnosis and management, this injury type is associated with significant morbidity and mortality, and long-term patient outcomes remain unclear.

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Traumatic lumbosacral instability: part 1 – proposing a definition and identifying underlying injury patterns

Lindtner,

Krappinger,

Lindahl

et al. 2024

Arch Orthop Trauma Surg

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Traumatic lumbosacral instability (TLSI) generally refers to a traumatic disruption of the lumbopelvic junction. The ambiguous use of this term has contributed to confusion and limited understanding of injuries that can impact lumbosacral stability. As of now, TLSI lacks a clear definition, and the underlying injury patterns remain inadequately characterized. Therefore, the objectives of the first part of this two-part series are: (1) to establish a precise definition of TLSI, (2) to identify and systematically characterize the injury patterns underlying TLSI, and (3) to outline principles for diagnosing and classifying these underlying conditions.

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Traumatic Complete Lateral Dislocation at the Lumbosacral Junction

Abstract: A combined anterior and posterior arthrodesis with decompression and instrumentation is an effective method for the treatment of this type of lumbosacral dislocation.

Cited by 12 publications

References 27 publications

Combined Posterior-Anterior Interbody Fusion in the Management of Traumatic Lumbosacral Dissociation: A Case Report and Review of Literature

Combined Posterior-Anterior Interbody Fusion in the Management of Traumatic Lumbosacral Dissociation: A Case Report and Review of Literature

Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Traumatic lumbosacral instability: part 1 – proposing a definition and identifying underlying injury patterns

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