Traumatic unilateral lumbosacral jumped facet without fracture in a child – presentation of a safe treatment strategy for a rare injury

Oszkar Szentirmai,Vikas Patel,Kathryn Beauchamp,Joshua Seinfeld

doi:10.1186/1754-9493-2-29

Oszkar Szentirmai, Vikas Patel + Show 2 more

Open Access

https://doi.org/10.1186/1754-9493-2-29

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Abstract

The vast majority of pediatric lumbosacral spondylolisthesis have developmental etiology. Of the very rare type of pediatric lumbosacral facet dislocations, there are only three reported cases of a pediatric unilateral jumped facet injury. All of these cases are associated with fracture dislocation of L5-S1. Hyperflexion with rotation is thought to provoke this uncommon type of spine injury.The authors report the first pediatric patient reported in literature to date with a traumatic unilateral jumped facet at the lumbosacral joint without fracture. The presentation, surgical treatment, hospital course, outcome and management options with the review of the literature is summarized.

Highlights

Unilateral jumped facet injuries are consequences of massive forces with a rotational component in the setting of hyperflexion
We found a total of approximately 50 traumatic lumbosacral facet dislocation cases reported in the literature. 21 cases are unilateral lumbosacral injuries. 3 of these cases are pediatric and are described as unilateral fracture-dislocations [1,2,3,4,5]
This is the first case reported in the PubMed literature database with an L5-S1 unilateral jumped facet injury with anterolisthesis but without associated L5-S1 fracture

Summary

Background

Unilateral jumped (or locked) facet injuries are consequences of massive forces with a rotational component in the setting of hyperflexion. On arrival to the hospital she was found to be neurologically intact but with limited range of motion in both legs due to pain in her back and pelvis Her workup revealed an L5-S1 anterolisthesis (Figure 1/A), a left L5-S1 unilateral jumped facet without evidence of fracture (Figure 1/B), a right greater than left sacroiliac dislocation (Figure 1/C), a left iliac wing fracture, multiple lumbar transverse process fractures, a C7 transverse process fracture and a T1 compression fracture. Two days following her accident, she was taken back to the operating room for right percutaneous sacroiliac screw placement for the reduction of the SI joint dislocation (Figure 3/C) The same week she was discharged home neurologically intact but with some subjective left leg weakness and numbness below the knee. She had a small patch of persistent numbness on the left shin which did not impede her activities

Discussion

Conclusion

Samberg LC