Unilateral Lumbosacral Dislocation: Case Report and a Comprehensive Review

Grivas, Theodoros B; Papadakis, Stamatios A.; Katsiva, Vassiliki; Koufopoulos, George; Mouzakis, Vassilios

doi:10.2174/1874325001206010473

Cited by 8 publications

(9 citation statements)

References 47 publications

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“…[12][13][14][15] There is only one other reported case of a pure bilateral dislocation outside the lumbosacral junction in an adult. 4 Common to these injuries are the mechanism of a high-speed motor vehicle accident, associated multisystem injuries, including abdominal solid organ and hollow viscus injuries, and prevalence of neurological deficits (more common in bilateral facet dislocations 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…1 Few reported cases have been described, and those that were typically involved the lumbosacral junction. 2,3 These injuries typically occur in younger patients as a result of flexion distraction forces on the spine and are associated with multisystem injuries. 4 We describe the presentation and management of a patient with bilateral lumbar facet dislocation with severe radiculopathy treated by using a posterior surgical decompression with short segmental reduction with instrumented fusion followed by an anterior interbody fusion through a lateral approach.…”

Section: Introductionmentioning

confidence: 99%

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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: 99%

Section: Introductionmentioning

confidence: 99%

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

Liu

Menga

2021

Int J Spine Surg

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“…Following the anterior procedure, we felt a short segment posterior arthrodesis across L5-S1 would be adequate to stabilize the L-S dissociation and proceeded with a posterior lumbar fusion. Both procedural techniques have been extensively published in the literature, with a range and variety of implants and instruments that can be utilized [6][7][8][9]. With the posterior procedure, the ligamentous complex was disrupted and there was a large gap in the lamina of L5-S1.…”

Section: Figure 3: Intraoperative Lateral X-ray Following the Anteriomentioning

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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“…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%

“…Traumatic lumbosacral dislocation is a rare clinical entity, characterized by unilateral or bilateral facet dislocations causing displacement at the level of the fifth lumbar vertebra in relation to the sacrum [ 1 ]. This injury pattern is caused by high-energy mechanisms such as motor vehicle collisions, falls from height, and crush injuries and is frequently associated with severe concomitant injuries [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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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Unilateral Lumbosacral Dislocation: Case Report and a Comprehensive Review

Cited by 8 publications

References 47 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

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

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