Two-level traumatic lateral lumbar fracture and dislocation in a heavy equipment operator: a case report

Abstract

Objective: Lumbar fracture-dislocations are rare and invariably due to high-energy trauma. The purpose of this study is to report the surgical management of a man with lateral lumbar dislocations in 2 noncontiguous lesions. Clinical features: A 49-year-old Asian man was crushed by a bulldozer. The patient was transported to a major medical center where he was found to be conscious, and the primary spinal injuries were fracture-dislocation of L1-L2 and L4-L5. His preoperative neurologic status showed a partial paraparesis to all motor groups of the lower extremities bilaterally. His radiological and operative findings showed a rupture of the thoracolumbar fascia and latissimus dorsi muscle, left L1-L2 dislocated facet, right L4-5 facet fracture, and dural tear. Intervention and outcome: The patient underwent a posterior reduction, decompression, instrumentation, and fusion surgery from T12 to S1 with autologous bone graft and pedicle screw instrumentation. Postoperatively, his neurologic status improved, allowing him to be ambulatory using a Lofstrand crutch with improved lumbosacral alignment being well maintained. Two weeks postoperatively, the patient regained voluntary bowel and bladder function. At the 1-year follow-up evaluation, his motor power was full in the left leg; however, sensation to pin prick remained lost on the right L5 and S1 distributions. He continued to ambulate using a Lofstrand crutch. Conclusion: Lateral lumbar fracture-dislocation at 2 noncontiguous levels is an unusual injury that results from high-energy trauma. Prompt recognition of the injuries, reduction of the fracture-dislocations, and posterior stabilization are recommended for neural decompression, spinal alignment, and long-term stabilization.

Acute Translation Fracture of the Lumbar Spine With Increased Motoric Outcomes: A Case Report

“…Spinal injuries involving complete fracture and dislocation often result in a complete loss of neurological function below the injury site, 10) while thoracolumbar fracture-dislocation has been shown to significantly reduce spinal stability. 5) The combination of shear, rotation, and flexion-extension damage affects the bone columns and the associated ligamentous structures 1 7) ; as a result, this condition significantly impacts the quality of life of individuals suffering from these injuries. 6) …”

“… 13) As a result, such injuries should be reduced and appropriately repaired as soon as possible. 5 7 12) …”

Traumatic Lumbar Spondylolisthesis: A Systematic Review and Case Series

“…Failure of nonoperative and nonfusion has been reported early in literature, with progression of the spondylolisthesis and secondary neurological impairment due to instability. 7,19,22,31,42-45 The time from injury to operative management is dictated by the neurology of the case and by associated injuries. 29 Although the timing of surgery is governed by the presence or progression of a neurologic deficit, ideally the deformity should be stabilized as soon as possible to mobilize the patient, since reduction becomes more difficult with time.…”