Lumbosacral Dislocation Research Articles

Acute traumatic L5–S1 spondylolisthesis: a case report

Case report of a patient treated surgically 2 months after sustaining a misdiagnosed acute traumatic lumbosacral dislocation is presented. The aims is to report in full about an uncommon case of anterior traumatic L5-S1 spondylolisthesis treated successfully with combined posterior stabilization and anterior fusion. Review of literature shows that traumatic lumbosacral dislocations and its treatment by open reduction and internal fixation are rare with only few well-documented case reports. We report the case of a 37-year-old man, who sustained a work-related traumatic lumbosacral dislocation. The delayed diagnosis of traumatic L5-S1 spondylolisthesis was initially missed and first treated, when the patient was transferred to the author's institution because of persistent neurological deficits. In the following the patient was successfully reduced and stabilized with posterior internal fixation and anterior interbody fusion. This case is documented in detail with radiographs, CT and MRI scans, as well as clinical pictures. At a 1.5-year follow-up complete fusion was achieved. The patient returned to work on the same job before injury, ambulating pain-free with a good subjective back-function and no limitations carrying out his recreational activities. At follow-up he had persistent sensible S1 nerve root deficits (ASIA grade E). Traumatic lumbosacral spondylolisthesis is a rare injury pattern. Its diagnosis can be missed initially, therefore computed tomography with biplanar reconstructions is mandatory in addition to good-quality conventional radiographs to plan and carry out such challenging management problems successfully. Surgical treatment for reduction, stabilization and interbody fusion is the method of choice.

Unilateral lumbosacral facet joint dislocation without associated fracture

In the lumbosacral spine, unilateral facet joint dislocation is an infrequent injury, which is often associated with fractures at the involved or other lumbar levels. The rare occurrence of unilateral lumbosacral facet joint dislocation without any associated fractures is presented with CT and MRI, and surgical correlation. To our knowledge, cross-sectional imaging of this injury has not previously been described in the published literature.

Traumatic Lumbosacral Dislocation

Diagnosis, physiopathology, and treatments of four patients with traumatic lumbosacral dislocations are described. This is a rare but severe lesion of the lumbosacral junction that usually occurs in patients with multiple trauma. It often is not thought of and the diagnosis may be missed. Evidence of lumbosacral dislocation should be examined and confirmed by computed tomography scans in patients with multiple fractures of transverse lumbar processes, asymmetric lumbosacral joints on frontal images, or slipping of L5 over S1 on lateral images. Treatment consists of reduction of the dislocated and fractured parts, lumbosacral arthrodesis, a posterolateral graft, and posterior instrumentation. Instrumentation may be short, extending from L5 to S1, or long, from L4 to S1, depending on the extension of the lesion. In some cases, reduction can be done intraoperatively, when the L4-S1 instrumentation is inserted, provided L5 transpedicle screws are pulled posteriorly. It usually is preferable to explore the vertebral canal to ensure that there is no disc lesion compressing the dura before proceeding with reduction. Compression of the dura could be avoided with a preoperative magnetic resonance imaging scan on which a lesion of the L5-S1 disc is sought. Additional interbody vertebral arthrodesis should be considered when the L5-S1 disc is affected severely. This lesion should be looked for preoperatively with a magnetic resonance imaging scan and intraoperatively by exploring the canal. This can be done at the time of the posterior surgery or during a second anterior surgical procedure.

Anterior Lumbosacral Dislocation: Case report and review of the literature

Background Anterior lumbosacral dislocation is a rare traumatic anterior spondylolisthesis. Methods We report a new case surgically treated and review the eight cases previously reported. Results The mechanism of injury is hyperflexion-distraction. Neurological signs are inconsistent. Indirect radiological signs such as bilateral multiple transverse process fractures are strongly suggestive of the diagnosis. This complete soft tissue injury induces a definitive instability and requires an open reduction with posterior fixation. Conclusions Suspicion of lumbosacral dislocation requires a computed tomography scan exploration with multiplanar reconstructions. Early reduction is associated with neurologic recovery. However, prognosis is correlated with the initial neurologic status and the severity of other associated injuries.

Posttraumatic Scoliosis

A case of posttraumatic scoliosis due a misdiagnosed lumbosacral unilateral dislocation was observed 6 weeks after a traffic injury in a 15-year-old boy. Cobb angle was 30 degrees on T10-L4 with 20 degrees rotation on L1 and L2. Initial radiographs were normal. The scoliosis was corrected after surgical correction of the dislocation; at 5-year follow-up, the patient worked normally; there was no scoliosis. The suggested physiopathology of this structural scoliosis is similar to spondylolisthetic scoliosis of childhood in which asymmetrical forward displacement of the vertebral body results in rotational shift of the vertebra, with lumbar scoliosis. Correction of the scoliosis depends on correction of the lumbosacral dislocation.

Traumatic Lumbosacral Dislocation in a 5-Year-Old Boy With Eight Years Follow-Up

The authors present an unusual case of pure traumatic bilateral lumbosacral dislocation in a 5-year-old boy, the conservative treatment carried out, and the long-term result. To describe a rare traumatic lesion in children and evaluate the result obtained with conservative treatment. Watson-Jones was the first to describe this type of lesion. Since then, only a few cases have been added. Most authors suggest that open reduction should be carried out. No cases of this type of injury in children have been reported. A 5-year-old boy was hit in the lumbosacral region with a rocking chair. Examination showed neurologic deficit of left L5 and S1 nerve roots. Roentgenographic examination and computed tomography scan confirmed the anterior dislocation of the fifth lumbar vertebra on the sacrum without any fracture. He was treated with traction, followed by hyperextension in a Cotrel traction table and further immobilization with a lumbar plaster jacket. Eight years after the injury, the patient had no neurologic deficit and lumbar radiographs showed a good alignment of the lumbosacral spine. In children with traumatic lumbosacral dislocation, closed reduction should be attempted even if neurologic deficit is present.

Traumatic Lumbosacral Dislocation: A Case Report and Review of the Literature

Traumatic Lumbosacral Dislocation: A Case Report and Review of the Literature

Closed reduction of lumbosacral fracture dislocations

A unique method for closed reduction of lumbosacral fracture dislocations that uses a circle-electric bed is described. Fine radiological description of the injury with computed tomography scanning allows the application of appropriate forces to facilitate the reduction, while having the patient awake during the procedure greatly reduces the chance of introducing further neurological deficit.

Complete lumbosacral dislocation: Report of a case

A case of complete lumbosacral dislocation is presented. This case was associated with multiple injuries complicating the problem. It demonstrates a continued stable entity without the need of additional fusion. In addition, the associated injuries were treated on a nondefinitive basis which was accompanied by a good result. While these methods are not intended to be recommended, they do demonstrate what can be done under unusual circumstances.