Traumatic Posterior L4–L5 Fracture Dislocation of the Lumbar Spine: A Case Report

Abstract

Study Design Case report. Objective The diagnosis and surgical management of a patient with traumatic bilateral posterior dislocation of L4–L5 is presented with a thorough review of the existing literature. Summary of Background Data Traumatic dislocation of L4–L5 has been reported in the English literature in only five cases; of these, only two were retrolisthesis. Methods A 20-year-old patient was involved in a high-energy vehicular accident and presented with back pain and inability to ambulate. Neurological assessment showed motor strength grade 2/5 in the proximal lower-extremity muscle groups (L1–L3 myotomes) and 0/5 strength distally (L4–S1 myotomes); in addition, incontinence of sphincters was found. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L4 vertebral body with complete posterior displacement of L4 to L5 vertebral body. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Results At 1-year follow-up, the patient had recovered muscular strength in proximal lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate with crutches. There was no recovery of distal extremity sensorimotor function. Plain radiograph and CT scan showed good alignment and progressive maturation of his fusion procedure. Conclusion Traumatic retrolisthesis of L4–L5 is a high-energy unstable fracture; reduction of the dislocation is challenging because of the heavy forces acting in the lower lumbar spine. Instrumented fusion restores alignment and maintains segmental stability.

A distraction technique using reduction multi-axial screws for open reduction of high-grade lumbar posterior dislocation:a case report and literature review

“…Baron et al reported a case of L4 vertebral fracture with posterior dislocation. The reduction was achieved by initial lengthening [9]. In severe fractures and dislocations, even with articular process interlocking, it is difficult to achieve perfect vertebral reduction by simply horizontal lengthening, and vertical pull-reduction of the dislocated vertebral body is necessary.…”

Traumatic Spondylolisthesis of the Fourth Lumbar Vertebra Without Neurologic Deficit or Fracture of the Posterior Elements

“…Especially, spondylolisthesis of the fourth lumbar vertebra (L4) is very rarely reported, while several cases with dislocation of the fifth lumbar vertebra (L5) over the first sacral vertebra (S1) have been described [1]. To our knowledge, there are only 16 studies with 18 patients reporting on L4 traumatic anterolisthesis, retrolisthesis, and spondyloptosis with or without concomitant fracture of the posterior vertebral elements [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Most of the patients in these reports were treated operatively with open reduction, intervertebral cages, pedicle screws, and rods fixation via the posterior approach.…”

Recovery after fracture dislocation of L3/L4 ASIA B: Case report

“…Reducing the dislocation is difficult due to the large forces acting on the lower lumbar spine. The purpose of surgery is to restore the anatomy through an appropriate reduction, maintain the reduction through instrumentation, reestablish sagittal balance, and promote fusion of the affected vertebrae [1] , [2] , [3] , [4] .…”

“…Although there is one case in the literature that reports spontaneous reduction of a fracture-dislocation when carrying out imaging studies [5] , there are few cases reported in the worldwide literature on recovery of neurological function after surgery, with adequate reduction of dislocations of distal segments of the lumbar region [2] , [3] , [6] , [7] , [8] , [9] .…”