Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Moon, Andrew S.; Ateşok, Kıvanç; Niemeier, Thomas E; Manoharan, Sakthivel Rajaram; Pittman, Jason L.; Theiss, Steven M.

doi:10.1155/2018/6578097

Cited by 15 publications

(24 citation statements)

References 89 publications

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“…A combination of the more sagittal alignment of the lumbar facet joints, larger vertebral bodies, and surrounding paraspinal musculature means that a very large flexion distraction force is required to separate the lumbar facet joints. 5 In our case, a high-speed, off-center frontal collision generated the distractive and rotational forces necessary to explain the injury of a seat-belted passenger.…”

Section: Discussionmentioning

confidence: 74%

Traumatic Bilateral L3-4 Facet Dislocation With Open Decompression and Short Segment Fusion

Liu

Menga

2021

Int J Spine Surg

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Traumatic lumbar facet dislocations are exceedingly rare, with reported cases primarily involving the lumbosacral junction. This injury arises from very high flexion distraction forces imparted on the lumbar spine. Herein we describe a bilateral L3-4 facet dislocation, a particularly rare injury pattern, using a short-segment posterior decompression and fusion followed by an interbody fusion through a lateral approach. Our case involves a 24-year-old man who presented to the emergency department after a high-speed, head-on motor vehicle collision. He was a restrained passenger with no prior significant medical history. He was found to have multisystem injuries, the most notable a L3-4 bilateral lumbar facet dislocation. The patient was neurologically intact upon his presentation but developed radiculopathy several hours into his hospital admission. He was treated operatively through a posterior decompression and instrumented shortsegment fusion as well as a subsequent interbody fusion through a lateral approach at the same level. Pure lumbar spine facet dislocations outside the lumbosacral junction, especially bilateral dislocations, are exceedingly rare and often result in neurological deficits. A literature review reveals only a few cases outside of Asia, all of which were treated with decompression and either short-or long-segment fusion. No accepted treatment algorithm for this injury has been established. Open treatment is almost always indicated. Decompression and short-segment fusion is a valid treatment option, but patient and injury characteristics must be considered on an individualized basis.Level of Evidence: 5.

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Section: Discussionmentioning

confidence: 74%

Traumatic Bilateral L3-4 Facet Dislocation With Open Decompression and Short Segment Fusion

Liu

Menga

2021

Int J Spine Surg

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“…The injury has a high association with many other injuries including neurological deficits producing a multisystem impact. Both conservative and operative interventions have been described without consensus on the standard of care [1,[2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…The operative intervention has been associated with earlier mobilization and better mechanical stability acutely. However, there is a relatively high infection rate as could be expected due to the soft tissue damage [2][3][4]8,9,[10][11][12]. There is at least one case treated conservatively with late fixation reporting a favorable clinical outcome [1].…”

Section: Introductionmentioning

confidence: 99%

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Lumbo-Pelvic Dissociation in a Patient With Complex Spinal Deformity: A Case Report

Rella¹,

Trent²,

Menger³

2022

Cureus

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Lumbopelvic dissociation is an extremely rare injury to the junction of the lumbar spine and sacrum seen in high-energy trauma, for which the operative treatment has not been established, especially in the setting of hardware infection. In this case report, we describe the case of a 37-year-old male who presented to the spine surgery team after undergoing six surgeries, all following a traumatic car accident ten years prior.The patient initially presented with symptomatic lumbar hyperlordosis that had progressively limited his ability to perform activities of daily living. He suffered from paraplegia and a sensory deficit at the T8 level and below but still maintained control over his bowel and bladder. The surgical team performed two operations: one to improve his quality of life by correcting the degree of lordosis he was suffering from due to a 76-degree sacral slope and the second to perform re-instrumentation after the patient suffered a traumatic injury three weeks after the initial operation that occurred after assisting with his own wheelchair transfers.His prior surgeries include operations for deformity correction as well as irrigation and debridement secondary to hardware infection and subsequent removal. He reported that following the hardware removal he had significant pain and was no longer able to easily sit and play with his child or reach countertops while in his wheelchair, severely impacting his quality of life.The surgical team performed two operations on this patient: the first to correct the lordotic deformity utilizing a four-rod construct, and a second performed three weeks later to perform re-instrumentation utilizing a five-rod construct and hematoma evacuation following hardware failure secondary to high biomechanical strain from performing his own wheelchair transfers.

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“…Most published reports and clinical series have shown that these injuries are commonly associated with motor vehicle accidents and are more prevalent in men than women, with an average age of around 27 years and typically bilateral dissociations with significant neurological deficits upon admission. The classification of complex lumbosacral injuries remains a controversial topic with various scoring systems taking into account the injury's morphology, posterior ligamentous complex integrity, and the patient's neurological status [1][2][3]. The severity of the injury results in chronic impairments, with early surgical intervention offering significant improvements in early mobilization, reduction in joint pain, mechanical stability, and possibly improved neurological outcomes [4][5].…”

Section: Introductionmentioning

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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Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Cited by 15 publications

References 89 publications

Traumatic Bilateral L3-4 Facet Dislocation With Open Decompression and Short Segment Fusion

Traumatic Bilateral L3-4 Facet Dislocation With Open Decompression and Short Segment Fusion

Lumbo-Pelvic Dissociation in a Patient With Complex Spinal Deformity: A Case Report

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

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