Abstract
Background:Traumatic unilateral facet dislocation without fracture is an uncommon injury of the lumbosacral junction. We describe a case of a unilateral perched L5–S1 facet causing axial back pain and radiculopathy provoked by motion.Case Description:The patient underwent reduction with complete facetectomy followed by internal fixation at L5–S1, facilitating decompression of the S1 nerve root. Postoperatively, the patient reported improvement in her pain.Conclusions:This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements. Despite its rarity, when identified, this injury can be characterized using the new TLICS system for thoracolumbar fractures and should be managed accordingly.
Highlights
Traumatic unilateral facet dislocation without fracture is an uncommon injury of the lumbosacral junction
Most reported cases of this injury pattern localize to the lumbosacral junction and have been managed both conservatively and, more recently, with open reduction and fusion.[1,2,5,8,9,11]
We describe a case of a unilateral perched L5–S1 facet causing axial back pain and radiculopathy provoked by motion, discuss the literature, and explain the rationale for treatment based on the Thoracolumbar Injury Classification and Severity (TLICS) classification
Summary
This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements. During evaluation at the community hospital, no gross signs of internal or external injuries and no neurologic deficit were noted; the patient complained of significant pain and spasms in the Surgical Neurology International 2011, 2:26 lower back, worsened by an upright position. She complained of right leg pain with a sharp quality when she would change position. Dynamic X-rays obtained at 6 months showed no significant motion at the operated level [Figure 6]
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